1174006233 NPI number — AMOR MEHTA MD - NEUROLOGY CENTER FOR EPILEPSY AND SEIZURES, LLC

Table of content: (NPI 1174006233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174006233 NPI number — AMOR MEHTA MD - NEUROLOGY CENTER FOR EPILEPSY AND SEIZURES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMOR MEHTA MD - NEUROLOGY CENTER FOR EPILEPSY AND SEIZURES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1174006233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
479 COUNTY ROAD 520
Provider Second Line Business Mailing Address:
SUITE 101-B, BUILDING B
Provider Business Mailing Address City Name:
MARLBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07746-1085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-856-5999
Provider Business Mailing Address Fax Number:
732-800-0662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
479 COUNTY ROAD 520
Provider Second Line Business Practice Location Address:
SUITE 101-B, BUILDING B
Provider Business Practice Location Address City Name:
MARLBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07746-1085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-856-5999
Provider Business Practice Location Address Fax Number:
732-800-0662
Provider Enumeration Date:
09/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MEHTA
Authorized Official First Name:
AMOR
Authorized Official Middle Name:
RUYINTAN
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
732-856-5999

Provider Taxonomy Codes

  • Taxonomy code: 2084E0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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