Healthcare Provider Details

I. General information

NPI: 1023699659
Provider Name (Legal Business Name): DIVY MEHRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

1305 YORK AVE
NEW YORK NY
10021-5663
US

V. Phone/Fax

Practice location:
  • Phone: 201-925-3597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number344156-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: