| Derrick M Desilva Jr. M.d. Llc | |
|
629 Amboy Ave 2nd Floor Edison NJ 08837-3579 | |
| (732) 738-8801 | |
| (732) 738-8802 |
| Full Name | Derrick M Desilva Jr. M.d. Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 629 Amboy Ave, Edison, New Jersey |
| Authorized Official Name and Position | Derrick M Desilva (OWNER) |
| Authorized Official Contact | 7327388801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Derrick M Desilva Jr. M.d. Llc 629 Amboy Ave 2nd Floor Edison NJ 08837-3579 Ph: (732) 738-8801 | Derrick M Desilva Jr. M.d. Llc 629 Amboy Ave 2nd Floor Edison NJ 08837-3579 Ph: (732) 738-8801 |
| NPI Number | 1295192706 |
|---|---|
| Provider Enumeration Date | 01/28/2016 |
| Last Update Date | 01/28/2016 |
| Medicare PECOS PAC ID | 2961708672 |
|---|---|
| Medicare Enrollment ID | O20160307001405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295192706 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA05140000 (New Jersey) | Primary |
| Provider Name | Derrick M Desilva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467541755 PECOS PAC ID: 3971415365 Enrollment ID: I20031104000336 |
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