Provider Demographics
NPI:1649810128
Name:MEHTA, HEMANGINEE DILIPBHAI
Entity type:Individual
Prefix:
First Name:HEMANGINEE
Middle Name:DILIPBHAI
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 1:320 SAINT PAULS AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5068
Mailing Address - Country:US
Mailing Address - Phone:201-554-8997
Mailing Address - Fax:
Practice Address - Street 1:320 SAINT PAULS AVE APT 3A
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5068
Practice Address - Country:US
Practice Address - Phone:201-554-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist