Active NPI
Meherwan Jamshed Mistry, M.D.
- Surgery Physician
- Matamoras, PA
National Provider Identifier
1629170295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD021779E
- Practice address
- 402 Delaware Dr
Matamoras, PA 18336-1058 - Phone
- (570) 491-4159
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 128983-1 | NY | |
| Surgery Physician | 208600000X | MD021779E | PA | Primary |
Addresses
Primary practice location
402 Delaware Dr
Matamoras, PA 18336-1058
Mailing address
402 Delaware Dr
Matamoras, PA 18336-1058
Phone (570) 491-4159
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128983-1 | NY | MD | Surgery Physician |
| MD021779E | PA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409788800000",
"number": "1629170295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 DELAWARE DR",
"city": "MATAMORAS",
"state": "PA",
"postal_code": "183361058",
"telephone_number": "570-491-4159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 DELAWARE DR",
"city": "MATAMORAS",
"state": "PA",
"postal_code": "183361058",
"telephone_number": "570-491-4159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISTRY",
"first_name": "MEHERWAN",
"middle_name": "JAMSHED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2014-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "128983-1",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD021779E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Matamoras, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.