Healthcare Provider Details

I. General information

NPI: 1619123759
Provider Name (Legal Business Name): TAPAN MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 HAMBURG TPKE
WAYNE NJ
07470-2156
US

IV. Provider business mailing address

246 HAMBURG TPKE
WAYNE NJ
07470-2156
US

V. Phone/Fax

Practice location:
  • Phone: 302-588-9847
  • Fax:
Mailing address:
  • Phone: 302-588-9847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number249258
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA09975300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: