Organization Active NPI

Mehta Medical PC

  • Internal Medicine Physician
  • Bronx, NY
National Provider Identifier
1861977316
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEHTA MEDICAL PC
Practice address
3979 Laconia Ave
Bronx, NY 10466-4916
Phone
(347) 442-7656
Fax
(347) 442-7049
NPI assigned
Oct 1, 2018
Last updated
Aug 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Authorized official

Name
Neeta Mehta, MDNPI 1578820379
Title
Owner
Phone
(718) 909-9378

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

3979 Laconia Ave
Bronx, NY 10466-4916

Mailing address

9 De Chiaro LN
Williston Park, NY 11596-1007
Phone (347) 442-7656

Other identifiers 1

IdentifierTypeStateIssuer
182250048MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181130000066 NY Part B Supplier - Clinic/Group Practice 5092059196 Receives reassigned benefits from 2 practitioners
Practice locations: Bronx, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2191643Mehta Medical PC3979 Laconia Avenue, Bronx, NY 10466Certificate of waiverAug 30, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1861977316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 DE CHIARO LN",
            "city": "WILLISTON PARK",
            "state": "NY",
            "postal_code": "115961007",
            "telephone_number": "347-442-7656",
            "fax_number": "347-442-7049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3979 LACONIA AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104664916",
            "telephone_number": "347-442-7656",
            "fax_number": "347-442-7049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEHTA MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-01",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "NEETA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-909-9378",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182250048",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.