Healthcare Provider Details

I. General information

NPI: 1912093444
Provider Name (Legal Business Name): DHIREN CHHOTALAL MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BAY AVENUE
EAST MORICHES NY
11940
US

IV. Provider business mailing address

36 OSPREY AVENUE
RIVERHEAD NY
11901
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-1543
  • Fax: 631-874-2559
Mailing address:
  • Phone: 631-727-4171
  • Fax: 631-727-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number197342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: