| Mira Desai, Llc | |
|
64 Conkling St Basking Ridge NJ 07920-1715 | |
| (917) 533-5871 | |
| Not Available |
| Full Name | Mira Desai, Llc |
|---|---|
| Speciality | Counselor |
| Location | 64 Conkling St, Basking Ridge, New Jersey |
| Authorized Official Name and Position | Mira Desai (OWNER) |
| Authorized Official Contact | 9175335871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mira Desai, Llc 64 Conkling St Basking Ridge NJ 07920-1715 Ph: (917) 533-5871 | Mira Desai, Llc 64 Conkling St Basking Ridge NJ 07920-1715 Ph: (917) 533-5871 |
| NPI Number | 1487429460 |
|---|---|
| Provider Enumeration Date | 11/20/2023 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Medicare PECOS PAC ID | 9133579402 |
|---|---|
| Medicare Enrollment ID | O20231228002484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487429460 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Mira Desai |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518623388 PECOS PAC ID: 0042660318 Enrollment ID: I20231228002719 |
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