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General NPI Number Information
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NPI Number | 1821186503
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Entity Type | Organization
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Legal Business Name | BASAVARAJ V DESAI MDPC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 205 EAST MAIN ST SUITE 2-6
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City | HUNTINGTON
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State | NY
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Zip | 11743
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Country | US
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Telephone | 631-549-1600
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Fax | 631-549-6839
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Provider Business Mailing Address
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Address Line | 205 EAST MAIN ST SUITE 2-6
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City | HUNTINGTON
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State | NY
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Zip | 11743
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Country | US
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Telephone | 631-549-1600
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Fax | 631-549-6839
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Authorized Official
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Title or Position | PRESIDENT
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Name | BASAVARAJ V DESAI
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Credential | MD
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Telephone | 631-549-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | K5897
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 1826741
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License Number State | NY
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