Provider Demographics
NPI:1225134661
Name:MEHTA, SUDHIR H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:H
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 1:201 UNION AVE
Mailing Address - Street 2:BLD. 2, SUITE B
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3002
Mailing Address - Country:US
Mailing Address - Phone:908-722-0106
Mailing Address - Fax:908-231-1431
Practice Address - Street 1:201 UNION AVE
Practice Address - Street 2:BLD. 2, SUITE B
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3002
Practice Address - Country:US
Practice Address - Phone:908-722-0106
Practice Address - Fax:908-231-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03213000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4767004Medicaid
192555PAUMedicare ID - Type Unspecified
NJ4767004Medicaid