Provider Demographics
NPI:1396752234
Name:MEHTA, NIMISH H (MD)
Entity type:Individual
Prefix:
First Name:NIMISH
Middle Name:H
Last Name:MEHTA
Suffix:
Gender:F
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:PO BOX 5075
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-5075
Mailing Address - Country:US
Mailing Address - Phone:856-616-8100
Mailing Address - Fax:856-616-1919
Practice Address - Street 1:2100 WESTCOTT DR
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:888-988-3404
Practice Address - Fax:856-616-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8958009Medicaid
H29776Medicare UPIN
NJ062189Medicare ID - Type Unspecified