Provider Demographics
NPI:1760590236
Name:MEHTA, VIPLOV KANU (MD, CMD)
Entity Type:Individual
Prefix:DR
First Name:VIPLOV
Middle Name:KANU
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:894 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3618
Practice Address - Country:US
Practice Address - Phone:718-774-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164845207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY274114OtherUNITED HEALTHCARE
NYKP685OtherOXFORD
NYN2408POtherHIP
NY4565872OtherAETNA (BLUE BELL)
NY01001053Medicaid
NY97D081OtherBLUE CHOICE
NY0003614OtherGHI
NY0C8521OtherPHS - HEALTHNET
NY0003614OtherGHI
NY0C8521OtherPHS - HEALTHNET