Basic Information
| Provider Information | |||||||||
| NPI: | 1851896344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | ANKURI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1991 MARCUS AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | NORTH NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110422058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167193376 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1991 MARCUS AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | NORTH NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110422058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167193376 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 315924 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.