Derrick M Desilva Jr. M.D. LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA05140000 Issued in NJ

Legal business name

DERRICK M DESILVA JR. M.D. LLC

Practice address

629 Amboy Ave
2ND Floor
Edison, NJ 08837-3579

Phone

(732) 738-8801

Fax

(732) 738-8802

NPI assigned

Jan 28, 2016

Last updated

Jan 28, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Derrick M Desilva Jr., MDNPI 1467541755

Title

Owner

Phone

(732) 738-8801

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derrick M Desilva Jr., MD

  • Internal Medicine Physician
  • Edison, NJ
  • NPI 1467541755
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453939200000",
    "number": "1295192706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 AMBOY AVE",
            "address_2": "2ND FLOOR",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088373579",
            "telephone_number": "732-738-8801",
            "fax_number": "732-738-8802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 AMBOY AVE",
            "address_2": "2ND FLOOR",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088373579",
            "telephone_number": "732-738-8801",
            "fax_number": "732-738-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK M DESILVA JR. M.D. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-28",
        "last_updated": "2016-01-28",
        "status": "A",
        "authorized_official_last_name": "DESILVA",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-738-8801",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA05140000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dino Corrado Derobertis, D.C.
• Derrick M. Desilva, Jr. MD
• Derrick M. Desilva, Jr. MD
• Aaditya Desai, DO
• Aaron Afraim Desai, MD
• Ami Desai, PHARMD

• Internal Medicine Physician in Edison, NJ
• Providers in Edison, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.