Healthcare Provider Details

I. General information

NPI: 1073864732
Provider Name (Legal Business Name): APEXA DESAI RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 86TH ST 502
NEW YORK NY
10028-3003
US

IV. Provider business mailing address

8853 RANSOM ST 2ND FLOOR
QUEENS VILLAGE NY
11427-2723
US

V. Phone/Fax

Practice location:
  • Phone: 212-744-2345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: