Provider Demographics
NPI:1942264452
Name:SUBHASH GOPAL MEHTA,MD,PA
Entity Type:Organization
Organization Name:SUBHASH GOPAL MEHTA,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-465-2299
Mailing Address - Street 1:510 BANK STREET
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-1468
Mailing Address - Country:US
Mailing Address - Phone:609-884-2122
Mailing Address - Fax:
Practice Address - Street 1:13 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-4221
Practice Address - Country:US
Practice Address - Phone:609-465-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03590200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ445113356OtherRAILROAD MEDICARE
NJ2991802Medicaid
NJ445113356OtherRAILROAD MEDICARE