Provider Demographics
NPI:1578526349
Name:MEHTA, LALIT HARGOVIND (MD)
Entity Type:Individual
Prefix:DR
First Name:LALIT
Middle Name:HARGOVIND
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 AZALEA TRAIL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1684
Mailing Address - Country:US
Mailing Address - Phone:190-823-3133
Mailing Address - Fax:120-197-4131
Practice Address - Street 1:1201 SUMMIT AVE.
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6213
Practice Address - Country:US
Practice Address - Phone:201-974-8949
Practice Address - Fax:201-974-1311
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04054500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0293709Medicaid
NJME199618Medicare ID - Type Unspecified
NJB20028Medicare UPIN