Provider Demographics
NPI:1417266982
Name:MEDICAL ARTS CLINIC PA
Entity Type:Organization
Organization Name:MEDICAL ARTS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LALIT
Authorized Official - Middle Name:HARGOVIND
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-974-8949
Mailing Address - Street 1:1201 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6287
Mailing Address - Country:US
Mailing Address - Phone:201-974-8949
Mailing Address - Fax:201-974-1311
Practice Address - Street 1:1201 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6287
Practice Address - Country:US
Practice Address - Phone:201-974-8949
Practice Address - Fax:201-974-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO4054500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care