Healthcare Provider Details

I. General information

NPI: 1154680478
Provider Name (Legal Business Name): VISHAL A. MEHTA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 N BROADWAY STE 306
YONKERS NY
10701-1308
US

IV. Provider business mailing address

984 N BROADWAY STE 306
YONKERS NY
10701-1308
US

V. Phone/Fax

Practice location:
  • Phone: 917-727-7646
  • Fax:
Mailing address:
  • Phone: 914-369-1700
  • Fax: 914-612-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number272831-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number272831-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: