Individual provider Active NPI

Jeet Thaker, M.D.

  • Family Medicine Physician
  • Egg Harbor Township, NJ
National Provider Identifier
1104358100
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA10876800 Issued in NJ
Practice address
2500 English Creek Ave Ste 909
Egg Harbor Township, NJ 08234-5587
Phone
(609) 407-2380
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA10876800 NJ Primary

Addresses

Primary practice location

2500 English Creek Ave Ste 909
Egg Harbor Township, NJ 08234-5587

Mailing address

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-1601

Other practice location 1

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 876-8319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200812000684 NJ Practitioner - Family Practice 3971937376 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

2500 English Creek Ave
Suite 909
Egg Harbor Township, NJ 08234-5587
Phone (609) 407-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Urgent Care Physicians LLC CurrentSince Sep 1, 2020 Accepting new patients
Atlanticare Physician Group PA Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Atlanticare Physician Group, PA CurrentSince Sep 1, 2020 Accepting new patients

Locations

2500 English Creek Ave
Ste 909
Egg Harbor Twp, NJ 08234
Phone (609) 407-2380

110 E Jimmie Leeds Rd
Galloway, NJ 08205
Phone (609) 408-4971

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

3131 Route 38
Ste 13
Mount Laurel, NJ 08054
Phone (856) 866-8700

3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1104358100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 ENGLISH CREEK AVE STE 909",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082345587",
            "telephone_number": "609-407-2380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2799 W Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-876-8319",
            "fax_number": "313-876-1302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THAKER",
        "first_name": "JEET",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA10876800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Egg Harbor Township, NJ

Sources for this page

Verify at the official NPI Registry.