Provider Demographics
NPI:1295783025
Name:MEHROTRA, NAVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:NAVEEN
Middle Name:
Last Name:MEHROTRA
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 1:652 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3559
Mailing Address - Country:US
Mailing Address - Phone:732-819-8800
Mailing Address - Fax:732-819-8801
Practice Address - Street 1:652 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3559
Practice Address - Country:US
Practice Address - Phone:732-738-1341
Practice Address - Fax:732-738-9585
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7504306Medicaid
NJG57592Medicare UPIN
NJNV016621Medicare ID - Type Unspecified