Basic Information
Provider Information
NPI: 1871869511
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DESAI
FirstName: VED
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 416457
Address2:  
City: BOSTON
State: MA
PostalCode: 022416457
CountryCode: US
TelephoneNumber: 8443621735
FaxNumber: 9732907495
Practice Location
Address1: 385 MORRIS AVE STE 100
Address2:  
City: SPRINGFIELD
State: NJ
PostalCode: 07081
CountryCode: US
TelephoneNumber: 9733792111
FaxNumber: 9733792807
Other Information
ProviderEnumerationDate: 03/27/2012
LastUpdateDate: 11/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X25MB10272100NJY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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