Provider Demographics
NPI:1275526709
Name:JHAVERI, MUKESH J (MD)
Entity Type:Individual
Prefix:MR
First Name:MUKESH
Middle Name:J
Last Name:JHAVERI
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 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2141
Mailing Address - Country:US
Mailing Address - Phone:845-342-4774
Mailing Address - Fax:
Practice Address - Street 1:24 GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4806
Practice Address - Country:US
Practice Address - Phone:845-343-4677
Practice Address - Fax:845-343-5249
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1393302084P0800X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00716129Medicaid
NJ0622508Medicaid
B14119Medicare UPIN
NJJH542732Medicare ID - Type Unspecified
NYMJ062A0810Medicare ID - Type Unspecified