Healthcare Provider Details

I. General information

NPI: 1326560764
Provider Name (Legal Business Name): JITESH DHINGRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVENUE HT 257 (BACK)
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

475 SEAVIEW AVENUE HT 257 (BACK)
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-8855
  • Fax:
Mailing address:
  • Phone: 718-226-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD478732
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: