Provider Demographics
NPI:1528370012
Name:MEHTA, MOHIT (PT)
Entity Type:Individual
Prefix:
First Name:MOHIT
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3903
Mailing Address - Country:US
Mailing Address - Phone:732-771-9023
Mailing Address - Fax:732-444-4326
Practice Address - Street 1:124 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4856
Practice Address - Country:US
Practice Address - Phone:732-771-9023
Practice Address - Fax:732-444-4326
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032531-1225100000X
NJ40QA01482400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03291196Medicaid