Provider Demographics
NPI:1730122649
Name:MEHTA, RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
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 1:66 W GILBERT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-235-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070438002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ221494442OtherTAX ID #
NJ60011743OtherHORIZON NJ HEALTH ID #
NJ8219773OtherGHI PPO ID #
NJ86559OtherAMERICAID ID #
NJP3191505OtherOXFORD ID #
NJ29404OtherUNIVERSITY HP ID #
NJ3416781OtherAETNA HMO ID #
NJ4453781OtherAETNA PPO ID #
NJ01000395001OtherAMERICHOICE ID #
NJ8226300Medicaid
NJ29404OtherUNIVERSITY HP ID #
NJ8226300Medicaid
NJ3416781OtherAETNA HMO ID #