Provider Demographics
NPI:1457442675
Name:SHREYA MEHTA DPM, PA
Entity Type:Organization
Organization Name:SHREYA MEHTA DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHREYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-865-2476
Mailing Address - Street 1:379 PARK ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2239
Mailing Address - Country:US
Mailing Address - Phone:917-865-2476
Mailing Address - Fax:
Practice Address - Street 1:350 BLOOMFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4852
Practice Address - Country:US
Practice Address - Phone:917-865-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00264000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8537101Medicaid
NJU85703Medicare UPIN
NJ8537101Medicaid