Provider Demographics
NPI:1639902687
Name:MEHTA, BHAVIK P (AGNP-C)
Entity type:Individual
Prefix:
First Name:BHAVIK
Middle Name:P
Last Name:MEHTA
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SADDLE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3503
Mailing Address - Country:US
Mailing Address - Phone:908-494-7755
Mailing Address - Fax:
Practice Address - Street 1:3100 QUAKERBRIDGE RD STE 28
Practice Address - Street 2:
Practice Address - City:HAMILTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-245-7430
Practice Address - Fax:732-463-5505
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15115200363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner