Healthcare Provider Details

I. General information

NPI: 1295783025
Provider Name (Legal Business Name): NAVEEN MEHROTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 AMBOY AVE
EDISON NJ
08837-3559
US

IV. Provider business mailing address

652 AMBOY AVE
EDISON NJ
08837-3559
US

V. Phone/Fax

Practice location:
  • Phone: 732-738-1341
  • Fax: 732-738-9585
Mailing address:
  • Phone: 732-819-8800
  • Fax: 732-819-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA64334
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7504306
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: