Healthcare Provider Details

I. General information

NPI: 1306082045
Provider Name (Legal Business Name): JIGNYASA DESAI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WEST 38 TH STREET SUITE 501
NEW YORK NY
10001
US

IV. Provider business mailing address

190 SYLVAN AVE STE 1
ENGLEWOOD CLIFFS NJ
07632-2542
US

V. Phone/Fax

Practice location:
  • Phone: 212-868-0509
  • Fax:
Mailing address:
  • Phone: 855-443-2544
  • Fax: 855-443-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB09000000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number262711
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number262711
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MB09000000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: