Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MA06133400 | NJ |
NPI | 1043408859 |
---|---|
Provider Name | Dr. Taral Divyakant Mehta |
First Address | Rockland, DE 19732-0191 |
Second Address | Pomona, NJ 08240-9104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 25/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055344 | (05) | NJ |
101225410 | (05) | PA |
4133072 | (05) | MD |