Provider Demographics
NPI:1396859385
Name:MEHTA, MAHESH M (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:M
Last Name:MEHTA
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 1:426 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514
Mailing Address - Country:US
Mailing Address - Phone:973-345-9595
Mailing Address - Fax:973-345-6996
Practice Address - Street 1:426 10TH AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514
Practice Address - Country:US
Practice Address - Phone:973-345-9595
Practice Address - Fax:973-345-6996
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO58201208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7689306Medicaid
NJ3K7509OtherHEALTH NET
NJ01004622700OtherAMERICHOICE
32752OtherAMERIGROUP
NJP3847821OtherOXFORD
NJ2567311OtherUNITED HEALTH CARE
NJ7689306Medicaid
32752OtherAMERIGROUP