Healthcare Provider Details

I. General information

NPI: 1316938376
Provider Name (Legal Business Name): DR. MUKESH B. DESAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CLINTON AVE
OSSINING NY
10562-4308
US

IV. Provider business mailing address

2 CLINTON AVE
OSSINING NY
10562-4308
US

V. Phone/Fax

Practice location:
  • Phone: 914-945-0305
  • Fax:
Mailing address:
  • Phone: 914-945-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number039689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: