Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 245503 | NY |
NPI | 1013181023 |
---|---|
Provider Name | Prem S. Mehta |
First Address | Mount Kisco, NY 10549-1009 |
Second Address | Nyack, NY 10960-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 22/04/2008 |