Healthcare Provider Details

I. General information

NPI: 1285063602
Provider Name (Legal Business Name): PRITIBEN B DESAI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEXINGTON RD STE A
WOOLWICH TOWNSHIP NJ
08085-1276
US

IV. Provider business mailing address

163 BRIDGETON PIKE
MULLICA HILL NJ
08062-2669
US

V. Phone/Fax

Practice location:
  • Phone: 856-223-0965
  • Fax: 856-223-1044
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-221-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15374300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000710
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: