Provider Demographics
NPI:1194761593
Name:DESAI, JAGDIP (MD)
Entity type:Individual
Prefix:
First Name:JAGDIP
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RARITAN REACH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3440
Mailing Address - Country:US
Mailing Address - Phone:732-709-3215
Mailing Address - Fax:908-994-5061
Practice Address - Street 1:1 CLARA MAASS DR
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3550
Practice Address - Country:US
Practice Address - Phone:908-705-6857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07787200207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDINGMedicaid
PENDINGMedicare UPIN
NJPENDINGMedicare ID - Type Unspecified