Provider Demographics
NPI:1902115553
Name:MEHTA, KUNAL PRADIP (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNAL
Middle Name:PRADIP
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4816
Mailing Address - Country:US
Mailing Address - Phone:516-222-2555
Mailing Address - Fax:516-745-5476
Practice Address - Street 1:975 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4816
Practice Address - Country:US
Practice Address - Phone:516-222-2555
Practice Address - Fax:516-745-5476
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279222207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400124865Medicare PIN