Provider Demographics
NPI:1316205396
Name:MEHTA, RUSHITA JAY (MD)
Entity Type:Individual
Prefix:
First Name:RUSHITA
Middle Name:JAY
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1040 1ST AVE # 138
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2991
Mailing Address - Country:US
Mailing Address - Phone:646-475-1749
Mailing Address - Fax:646-809-8581
Practice Address - Street 1:715 PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5047
Practice Address - Country:US
Practice Address - Phone:646-475-1749
Practice Address - Fax:646-809-8581
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY280108207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY454057724OtherTAX ID