Basic Information
| Provider Information | |||||||||
| NPI: | 1225137797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | ANJALI | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 196 GROVE AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WEST DEPTFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080862139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568487577 | ||||||||
| FaxNumber: | 8568486554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD423271 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MA077033 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0081663 | 05 | NJ | MEDICAID | 1713909 | 01 | NJ | CIGNA HEALTH PLAN | OTHER | P3597144 | 01 | NJ | OXFORD HEALTH PLAN | OTHER | 1595039 | 01 | PA | AMERIHEALTH PPO PABS | OTHER | 01000765000 | 01 | NJ | AMERICHOICE | OTHER | 3985113 | 01 | NJ | AETNA- US HEALTHCARE | OTHER | 3985123 | 01 | NJ | AETNA US HEALTHCARE | OTHER | 3K6104 | 01 | NJ | HEALTHNET, INC | OTHER | 2272553000 | 01 | NJ | AMERIHEALTH HMO | OTHER | 2469030 | 01 | NJ | UNITED HEALTHCARE | OTHER | 60021595 | 01 | NJ | HORIZON-NJ HEALTH | OTHER | 60021597 | 01 | NJ | HORIZON- NJ HEALTH | OTHER | P00298838 | 01 | NJ | RAILROAD MEDICARE | OTHER |