Provider Demographics
NPI:1003228834
Name:MEHTA, POOJA (PT)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE ST
Mailing Address - Street 2:SUITE 71
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1543
Mailing Address - Country:US
Mailing Address - Phone:914-375-3434
Mailing Address - Fax:914-375-3402
Practice Address - Street 1:1 BRIDGE ST
Practice Address - Street 2:SUITE 71
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1543
Practice Address - Country:US
Practice Address - Phone:914-375-3434
Practice Address - Fax:914-375-3402
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY036671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6W8B1Medicare UPIN