Healthcare Provider Details

I. General information

NPI: 1003278037
Provider Name (Legal Business Name): JITEN DESAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-1000
  • Fax:
Mailing address:
  • Phone: 609-652-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA190138
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA12643600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: