1144268103 NPI number — RAVI K DESAI, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144268103 NPI number — RAVI K DESAI, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAVI K DESAI, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144268103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 626
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12065-0626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-383-5450
Provider Business Mailing Address Fax Number:
518-383-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 MIDDLESEX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14216-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-445-6128
Provider Business Practice Location Address Fax Number:
518-383-4223
Provider Enumeration Date:
06/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
RAVI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
716-445-6128

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)