Individual provider Active NPI

Paayal P Mehta, MD

  • Surgery Physician
  • Riverhead, NY
National Provider Identifier
1114951613
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
234672-1 Issued in NY
Practice address
715 Roanoke Ave
Suite 1
Riverhead, NY 11901-2729
Phone
(631) 963-4750
Fax
(631) 591-1842
NPI assigned
Jul 10, 2006
Last updated
Sep 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 234672-1 NY Primary

Addresses

Primary practice location

715 Roanoke Ave
Suite 1
Riverhead, NY 11901-2729

Mailing address

715 Roanoke Ave
Suite 1
Riverhead, NY 11901-2729
Phone (631) 963-4750

Other identifiers 1

IdentifierTypeStateIssuer
02635532MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
234672-1NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suffolk Surgical Group, PC Surgery PastSince Feb 5, 2012 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1114951613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 ROANOKE AVE",
            "address_2": "SUITE 1",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012729",
            "telephone_number": "631-963-4750",
            "fax_number": "631-591-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 ROANOKE AVE",
            "address_2": "SUITE 1",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012729",
            "telephone_number": "631-963-4750",
            "fax_number": "631-591-1842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "PAAYAL",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "234672-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02635532",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

Verify at the official NPI Registry.