Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 33984 | NJ |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 33984 | NJ |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 33984 | NJ |
N | 2081P2900X | Pain Medicine | 33984 | NJ |
N | 2081S0010X | Sports Medicine | 33984 | NJ |
N | 213ES0000X | Sports Medicine | 33984 | NJ |
N | 2084V0102X | Vascular Neurology | 33984 | NJ |
NPI | 1427099985 |
---|---|
Provider Name | Monica Mehta |
First Address | Jersey City, NJ 07306-1112 |
Second Address | Jersey City, NJ 07306-1133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3163601 | (05) | NJ |
D06820 | (02) | NJ |