Healthcare Provider Details

I. General information

NPI: 1144553512
Provider Name (Legal Business Name): FRENNY R MEHTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD STE 100
PLAINVIEW NY
11803-4938
US

IV. Provider business mailing address

651 OLD COUNTRY RD STE 100
PLAINVIEW NY
11803-4938
US

V. Phone/Fax

Practice location:
  • Phone: 516-935-1958
  • Fax: 516-827-0713
Mailing address:
  • Phone: 516-935-1958
  • Fax: 516-827-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number031886
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: