Provider Demographics
NPI:1861715161
Name:MEHTA, MANSI (PHARMD)
Entity type:Individual
Prefix:
First Name:MANSI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W 37TH ST
Mailing Address - Street 2:APT 2806
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1257
Mailing Address - Country:US
Mailing Address - Phone:917-498-7281
Mailing Address - Fax:
Practice Address - Street 1:542-576, 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6307
Practice Address - Country:US
Practice Address - Phone:212-213-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232520183500000X
NY20053342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist