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NPI Code Detail

MEDICARE: KENNETH DESA M.D.

MEDICARE: KENNETH DESA M.D.
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
1207Q00000XFamily Medicine Physician247544NY
2207Q00000XFamily Medicine PhysicianX001263NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841234895
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DESA M.D.
Provider Business Mailing Address
First Line : 1037 MAIN ST
Second Line :
City : PEEKSKILL
State : NY
Zip : 10566-2913
Country : US
Telephone Number : 914-734-8800
Fax Number : 914-734-8745
Provider Business Practice Location Address
First Line : 6 HENRY ST
Second Line :
City : BEACON
State : NY
Zip : 12508-3058
Country : US
Telephone Number : 845-831-0400
Fax Number : 845-831-0793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 07/01/2020

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Directions to “ KENNETH DESA M.D.” Practice Location

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