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General NPI Number Information
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NPI Number | 1073584868
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Entity Type | Individual
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Provider Name | RAGHUNATH MEHTA M.D
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 40 WAYNE LN
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City | TAPPAN
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State | NY
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Zip | 10983-1117
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Country | US
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Telephone | 845-365-3968
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Fax | 845-365-3968
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Provider Business Mailing Address
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Address Line | 40 WAYNE LN
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City | TAPPAN
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State | NY
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Zip | 10983-1117
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Country | US
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Telephone | 845-365-3968
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Fax | 845-365-3968
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 105948
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 105948
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 105948
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License Number State | NY
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