Provider Demographics
NPI:1154680478
Name:MEHTA, VISHAL A (DO)
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:A
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 N BROADWAY STE 306
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1308
Mailing Address - Country:US
Mailing Address - Phone:914-369-1700
Mailing Address - Fax:914-612-7883
Practice Address - Street 1:984 N BROADWAY STE 306
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:917-727-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272831-1207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine