Individual
ANISH DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776-8054
(631) 978-7633
(631) 621-4119
Mailing address
1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776-8054
(631) 978-7633
(631) 686-2578
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
280824
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04494735
—
NY
Enumeration date
12/02/2012
Last updated
04/29/2022
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