Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 208831-1 | NY |
NPI | 1013020593 |
---|---|
Provider Name | Kalpana Pankaj Desai |
First Address | Lady Lake, FL 32159-6340 |
Second Address | Lady Lake, FL 32159-6340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I08088 | (02) | NY |