Provider Demographics
NPI:1013181023
Name:MEHTA, PREM S (MD)
Entity Type:Individual
Prefix:
First Name:PREM
Middle Name:S
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KENSICO DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1009
Mailing Address - Country:US
Mailing Address - Phone:914-666-8866
Mailing Address - Fax:914-666-6777
Practice Address - Street 1:160 N MIDLAND AVE
Practice Address - Street 2:NYACK HOSPITAL
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1912
Practice Address - Country:US
Practice Address - Phone:845-348-2862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245503207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine