Organization
113TH STREET MEDICAL GROUP, PC
Active
Organization
113TH STREET MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GIRISH N DESAI M.D. (DIRECTOR)
(718) 990-4645
Entity
Organization
Contact information
Practice address
7035 113TH ST, FOREST HILLS, NY 11375-4651
(718) 990-4255
(718) 990-4624
Mailing address
7035 113TH ST, FOREST HILLS, NY 11375-4651
(718) 990-4255
(718) 990-4624
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Enumeration date
07/17/2007
Last updated
07/17/2007
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