Healthcare Provider Details

I. General information

NPI: 1982163176
Provider Name (Legal Business Name): ATLAS ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 10/12/2023
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ANNETT AVE
EDGEWATER NJ
07020-1530
US

IV. Provider business mailing address

23 ANNETT AVE
EDGEWATER NJ
07020-1530
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1210
  • Fax: 201-342-1259
Mailing address:
  • Phone: 201-342-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JIGNYASA DESAI
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: DO
Phone: 201-342-1205