MEDICARE: POOJA MEHULKUMAR DESAI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	034846	NY

General Provider Information

NPI Number	:	1104795152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POOJA MEHULKUMAR DESAI PA-C

Provider Business Mailing Address
First Line	:	2715 30TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-2445
Country	:	US
Telephone Number	:	215-904-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 30TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-2445
Country	:	US
Telephone Number	:	718-685-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/29/2025

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