Provider Demographics
NPI:1073545109
Name:MEHTA, LEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEENA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2716
Mailing Address - Country:US
Mailing Address - Phone:585-385-9030
Mailing Address - Fax:585-385-9124
Practice Address - Street 1:2211 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5743
Practice Address - Country:US
Practice Address - Phone:585-429-5555
Practice Address - Fax:585-429-6581
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140922207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102343APOtherPREFERRED CARE
NY7701501OtherMVP
NY88249OtherGHI
NY005299541OtherCOMMUNITY BLUE
NY9351OtherBLUE SHIELD
NYP010140922OtherBLUE CHOICE
NY2655649OtherAETNA
NY7701501OtherMVP
NY2655649OtherAETNA