Provider Demographics
NPI: | 1013077395 |
---|---|
Name: | MEHTA, ARIZ RUYINTAN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ARIZ |
Middle Name: | RUYINTAN |
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: | 191 PALISADE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | JERSEY CITY |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07306-1112 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-656-4324 |
Mailing Address - Fax: | 201-656-4019 |
Practice Address - Street 1: | 191 PALISADE AVE |
Practice Address - Street 2: | |
Practice Address - City: | JERSEY CITY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07306-1112 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-656-4324 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-09 |
Last Update Date: | 2021-10-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 233661-1 | 204C00000X, 204D00000X, 2080S0010X, 208100000X, 2081P0004X, 2081P0010X, 2081P2900X, 2081S0010X, 208VP0000X, 208VP0014X, 209800000X |
NJ | 25MA07825600 | 2085B0100X, 2085D0003X, 2085R0202X, 2085U0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | |
No | 2080S0010X | Allopathic & Osteopathic Physicians | Pediatrics | Sports Medicine |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | |
No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine |
No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No | 209800000X | Allopathic & Osteopathic Physicians | Legal Medicine | |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No | 2085D0003X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
109101 | Medicare PIN | ||
I72005 | Medicare UPIN |