Provider Demographics
NPI:1801851282
Name:MEHTA, PANKAJ J (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:J
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1462 ERIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHDY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4154
Practice Address - Fax:518-243-1441
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1861272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26151OtherMVP
NY7943098OtherAETNA
NY000406821001OtherBLUE SHIELD
NY10001348OtherCDPHP
NY040426032049OtherFIDELIS
NY11268735OtherCAQH
NY97K221OtherBLUE CROSS
NY10001348OtherCDPHP
F41677Medicare UPIN