Provider Demographics
NPI:1225190705
Name:MEHTA, KUMUDINI U (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMUDINI
Middle Name:U
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:208 GOLF EDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1806
Mailing Address - Country:US
Mailing Address - Phone:908-654-3615
Mailing Address - Fax:908-654-1931
Practice Address - Street 1:1 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1011
Practice Address - Country:US
Practice Address - Phone:201-393-5132
Practice Address - Fax:201-462-6757
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ596155Medicare UPIN
NJ1927001Medicare ID - Type Unspecified