Provider Demographics
NPI:1912093444
Name:MEHTA, DHIREN CHHOTALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DHIREN
Middle Name:CHHOTALAL
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36 OSPREY AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-727-4171
Mailing Address - Fax:631-727-3660
Practice Address - Street 1:41 BAY AVENUE
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940
Practice Address - Country:US
Practice Address - Phone:631-878-1543
Practice Address - Fax:631-874-2559
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197342207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01676080Medicaid
NY197342OtherLICENCE NUMBER
NY197342OtherLICENCE NUMBER
NY06N841Medicare UPIN
NY01676080Medicaid