Provider Demographics
NPI:1366545402
Name:MEHTA, SATISH R (MD)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:R
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:40 DARTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3912
Mailing Address - Country:US
Mailing Address - Phone:973-273-1515
Mailing Address - Fax:973-230-0883
Practice Address - Street 1:194 CLINTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-2809
Practice Address - Country:US
Practice Address - Phone:973-273-1515
Practice Address - Fax:973-230-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2021-02-12
Deactivation Date:2008-04-23
Deactivation Code:
Reactivation Date:2008-07-23
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03829100207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3275001Medicaid
NJ3275001Medicaid
NJC56660Medicare UPIN