Provider Demographics
NPI:1518099860
Name:MEHROTRA, DEEPTI (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTI
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEEPTI
Other - Middle Name:
Other - Last Name:MEHROTRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:535 S BROADWAY STE 1
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5029
Mailing Address - Country:US
Mailing Address - Phone:516-719-0344
Mailing Address - Fax:516-719-0345
Practice Address - Street 1:535 S BROADWAY STE 1
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5029
Practice Address - Country:US
Practice Address - Phone:516-719-0344
Practice Address - Fax:516-719-0345
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2115972080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine