Healthcare Provider Details

I. General information

NPI: 1942465521
Provider Name (Legal Business Name): MEHTA & MEHTA PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OSPREY AVE
RIVERHEAD NY
11901-7303
US

IV. Provider business mailing address

41 BAY AVE
EAST MORICHES NY
11940-1209
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-4171
  • Fax: 631-727-3660
Mailing address:
  • Phone: 631-878-1543
  • Fax: 631-878-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number170734
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number197342
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number198176
License Number StateNY

VIII. Authorized Official

Name: DR. RANJANA D MEHTA
Title or Position: PATNER
Credential: MD
Phone: 631-878-1543