Healthcare Provider Details

I. General information

NPI: 1013077395
Provider Name (Legal Business Name): ARIZ RUYINTAN MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 PALISADE AVE
JERSEY CITY NJ
07306-1112
US

IV. Provider business mailing address

191 PALISADE AVE
JERSEY CITY NJ
07306-1112
US

V. Phone/Fax

Practice location:
  • Phone: 201-656-4324
  • Fax:
Mailing address:
  • Phone: 201-656-4324
  • Fax: 201-656-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number233661-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number233661-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number233661-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number233661-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number233661-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number233661-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number233661-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number233661-1
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number233661-1
License Number StateNY
# 10
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number233661-1
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number233661-1
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number25MA07825600
License Number StateNJ
# 13
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number25MA07825600
License Number StateNJ
# 14
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07825600
License Number StateNJ
# 15
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number25MA07825600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: