Provider Demographics
NPI:1144338641
Name:DESAI, RAJENDRA (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
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 1:116 MILLBURN AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1943
Mailing Address - Country:US
Mailing Address - Phone:973-376-8454
Mailing Address - Fax:973-376-7808
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-376-8454
Practice Address - Fax:973-376-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7316500Medicaid
NJ002837Medicare ID - Type Unspecified
NJG60681Medicare UPIN