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

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.

Title

Medical Director

Phone

(617) 922-4957

Specialties & licenses 1

Addresses

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.