Idaho Memory & Aging Center PLLC

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

M-12079 Issued in ID

Legal business name

IDAHO MEMORY & AGING CENTER PLLC

Practice address

413 N Allumbaugh St
Ste# 101
Boise, ID 83704-9212

Phone

(617) 922-4957

NPI assigned

Jun 14, 2013

Last updated

Jul 19, 2013By 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

Dr. Abhilash K Desai, M.D.NPI 1366519084

Title

Medical Director

Phone

(617) 922-4957

Specialties & licenses 1

Addresses

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.

• Abhilash Desai

  • Psychiatry Physician
  • Boise, ID
  • NPI 1366519084
  Authorized official Same address or phone

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

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374192000000",
    "number": "1730528548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N ALLUMBAUGH ST",
            "address_2": "STE# 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049212",
            "telephone_number": "617-922-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N ALLUMBAUGH ST",
            "address_2": "STE# 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049212",
            "telephone_number": "617-922-4957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO MEMORY & AGING CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-14",
        "last_updated": "2013-07-19",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "ABHILASH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "617-922-4957",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "ID",
            "license": "M-12079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Psychiatry Physician in Boise, ID
• Providers in Boise, ID by specialty
• Geriatric Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.