Provider Demographics
NPI:1366541690
Name:DESAI, MAHESH R (MD)
Entity type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:R
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:120 MILLBURN AVENUE
Mailing Address - Street 2:SUITE M2
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1935
Mailing Address - Country:US
Mailing Address - Phone:973-467-5900
Mailing Address - Fax:973-467-8169
Practice Address - Street 1:120 MILLBURN AVENUE
Practice Address - Street 2:SUITE M2
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-467-5900
Practice Address - Fax:973-467-8169
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036146266207RG0100X
NJ25MA03499900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3046109Medicaid
C56256Medicare UPIN
NJ3046109Medicaid