Provider Demographics
NPI:1073584868
Name:MEHTA, RAGHUNATH (MD)
Entity type:Individual
Prefix:DR
First Name:RAGHUNATH
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WAYNE LN
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1117
Mailing Address - Country:US
Mailing Address - Phone:845-365-3968
Mailing Address - Fax:845-365-3968
Practice Address - Street 1:40 WAYNE LN
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1117
Practice Address - Country:US
Practice Address - Phone:845-365-3968
Practice Address - Fax:845-365-3968
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1059482084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00662588Medicaid
NYA62965Medicare UPIN
NY49A051Medicare ID - Type UnspecifiedPART B