Provider Demographics
NPI:1487766416
Name:DESANTI, MICHELINA (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELINA
Middle Name:
Last Name:DESANTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 STATE ROUTE 94
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07832-2523
Mailing Address - Country:US
Mailing Address - Phone:908-496-9400
Mailing Address - Fax:908-496-9414
Practice Address - Street 1:576 STATE ROUTE 94
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2523
Practice Address - Country:US
Practice Address - Phone:908-496-9400
Practice Address - Fax:908-496-9414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05592900207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6444300Medicaid
NJF16592OtherHEALTHNET
NJ0974420OtherAETNA
NJXP031OtherOXFORD
NJ1817916OtherUNITED HEALTHCARE
NJ4201059OtherCIGNA
NJ223554030OtherHORIZON BCBS
NJ0974420OtherAETNA
NJF93760Medicare UPIN