Provider Demographics
NPI:1306839097
Name:MEHTA, BIJAL SHAH (MD)
Entity Type:Individual
Prefix:DR
First Name:BIJAL
Middle Name:SHAH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BAY AVE
Mailing Address - Street 2:ATTN: BIJAL MEHTA, 2ND FLOOR, DEPARTMENT OF MEDICINE
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4837
Mailing Address - Country:US
Mailing Address - Phone:973-429-6195
Mailing Address - Fax:
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:ATTN: BIJAL MEHTA, 2ND FLOOR, DEPARTMENT OF MEDICINE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-429-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01863767Medicaid
NYG66573Medicare UPIN
NY30N93Medicare ID - Type Unspecified