Provider Demographics
NPI:1932477049
Name:MEHTA, PUJA DESAI (OD)
Entity Type:Individual
Prefix:DR
First Name:PUJA
Middle Name:DESAI
Last Name:MEHTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PUJA
Other - Middle Name:KIRTI
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:29 RODAK CIR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4766
Mailing Address - Country:US
Mailing Address - Phone:848-219-1964
Mailing Address - Fax:
Practice Address - Street 1:1225 GERARD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8001
Practice Address - Country:US
Practice Address - Phone:718-960-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00657500152W00000X
NYTUV007769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist