Provider Demographics
NPI:1578820379
Name:MEHTA, NEETA (MD)
Entity Type:Individual
Prefix:
First Name:NEETA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 LACONIA AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4916
Mailing Address - Country:US
Mailing Address - Phone:347-442-7656
Mailing Address - Fax:347-442-7049
Practice Address - Street 1:3979 LACONIA AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4916
Practice Address - Country:US
Practice Address - Phone:347-442-7656
Practice Address - Fax:347-442-7049
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055096207R00000X
390200000X
NY291308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY182250048Medicaid