Provider Demographics
NPI:1821017344
Name:MEHTA, NIKUNJ P (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKUNJ
Middle Name:P
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 1:9 MULE RD STE 14E
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5053
Mailing Address - Country:US
Mailing Address - Phone:732-244-1080
Mailing Address - Fax:732-244-1130
Practice Address - Street 1:9 MULE RD STE E14
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5053
Practice Address - Country:US
Practice Address - Phone:732-244-1080
Practice Address - Fax:732-244-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 43305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00718633OtherRAILROAD MEDICARE
NJ3947203Medicaid
NJ120267Medicare PIN
NJ3947203Medicaid