Provider Demographics
NPI:1558566471
Name:MEHTA, AMOR RUYINTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOR
Middle Name:RUYINTAN
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 1:479 COUNTY ROAD 520
Mailing Address - Street 2:SUITE 101-B, BUILDING B
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1085
Mailing Address - Country:US
Mailing Address - Phone:732-856-5999
Mailing Address - Fax:732-800-0662
Practice Address - Street 1:479 COUNTY ROAD 520
Practice Address - Street 2:SUITE 101-B, BUILDING B
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1085
Practice Address - Country:US
Practice Address - Phone:732-856-5999
Practice Address - Fax:732-800-0662
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA088609002084N0400X, 2084N0600X
NY2590052084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08860900OtherNJ STATE BOARD OF MEDICAL EXAMINERS LICENSE
NY259005OtherNY STATE BOARD
NY259005OtherNY STATE BOARD