Healthcare Provider Details

I. General information

NPI: 1134145857
Provider Name (Legal Business Name): ANAND I DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BLACK RIVER BLVD N STE 200
ROME NY
13440-2427
US

IV. Provider business mailing address

1801 BLACK RIVER BLVD N STE 200
ROME NY
13440-2427
US

V. Phone/Fax

Practice location:
  • Phone: 315-336-7255
  • Fax: 315-339-2949
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number149307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: