1396859385 NPI number — MR. MAHESH M MEHTA MD

Table of content: MR. MAHESH M MEHTA MD (NPI 1396859385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396859385 NPI number — MR. MAHESH M MEHTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
MAHESH
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396859385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 10TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-345-9595
Provider Business Mailing Address Fax Number:
973-345-6996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-345-9595
Provider Business Practice Location Address Fax Number:
973-345-6996
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MAO58201 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7689306 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3K7509 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01004622700 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 32752 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3847821 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2567311 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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