Provider Demographics
NPI:1477600971
Name:DESAI, AMITA S (MD)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:S
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 NOLEN CIR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4110
Mailing Address - Country:US
Mailing Address - Phone:856-264-9025
Mailing Address - Fax:
Practice Address - Street 1:383 WEST STATE STREET
Practice Address - Street 2:CATHOLIC CHARITIES
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-394-5181
Practice Address - Fax:609-386-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA0540532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA054053OtherNJ MEDICAL LICENSE
NJMA054053OtherNJ MEDICAL LICENSE