Provider Demographics
NPI:1265065692
Name:MEHTA, KAVYA KSHITIJ
Entity type:Individual
Prefix:
First Name:KAVYA
Middle Name:KSHITIJ
Last Name:MEHTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEW YORK PLZ
Mailing Address - Street 2:CONCOURSE LEVEL, SUITE L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1901
Mailing Address - Country:US
Mailing Address - Phone:646-886-8687
Mailing Address - Fax:212-656-1091
Practice Address - Street 1:30 WALL ST STE 500
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2206
Practice Address - Country:US
Practice Address - Phone:646-886-8687
Practice Address - Fax:212-656-1091
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty