Provider Demographics
NPI:1235339326
Name:MEHTA, KEYUR (MD)
Entity Type:Individual
Prefix:
First Name:KEYUR
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 POPLAR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2648
Mailing Address - Country:US
Mailing Address - Phone:718-405-8560
Mailing Address - Fax:718-405-8561
Practice Address - Street 1:1625 POPLAR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2648
Practice Address - Country:US
Practice Address - Phone:718-405-8560
Practice Address - Fax:718-405-8561
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2566842085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology