Healthcare Provider Details

I. General information

NPI: 1649250697
Provider Name (Legal Business Name): DEEPTI MEHRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE RD SUITE 213
LITTLE SILVER NJ
07739-1150
US

IV. Provider business mailing address

311 W SYLVANIA AVE #233-A
NEPTUNE NJ
07753-5977
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-5600
  • Fax: 732-345-1001
Mailing address:
  • Phone: 732-988-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07009100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: