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General NPI Number Information
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NPI Number | 1649093733
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Entity Type | Individual
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Provider Name | HETA MEHTA
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Gender | Female
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 3648 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10031-2520
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Country | US
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Telephone | 212-281-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 JOHN F KENNEDY BLVD APT 22
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City | JERSEY CITY
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State | NJ
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Zip | 07306-3666
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Country | US
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Telephone | 201-736-8957
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 050303-01
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License Number State | NY
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