Provider Demographics
NPI:1114951613
Name:MEHTA, PAAYAL P (MD)
Entity Type:Individual
Prefix:
First Name:PAAYAL
Middle Name:P
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 1:715 ROANOKE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2729
Mailing Address - Country:US
Mailing Address - Phone:631-963-4750
Mailing Address - Fax:631-591-1842
Practice Address - Street 1:715 ROANOKE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2729
Practice Address - Country:US
Practice Address - Phone:631-963-4750
Practice Address - Fax:631-591-1842
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234672-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635532Medicaid
NY3740H1Medicare PIN
I23576Medicare UPIN