Provider Demographics
NPI:1962648832
Name:SRINIVASAN-MEHTA, JAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:
Last Name:SRINIVASAN-MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:ST. JOSEPH'S CHILDREN'S HOSPITAL- RM X609
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:ST. JOSEPH'S CHILDREN'S HOSPITAL- RM X609
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2535
Practice Address - Fax:973-754-3389
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA095946002080P0216X
NY2626362080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology