Provider Demographics
NPI:1538353933
Name:MEHTA, VISHAL (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
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 1:1 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9590
Mailing Address - Country:US
Mailing Address - Phone:609-924-0200
Mailing Address - Fax:609-924-0201
Practice Address - Street 1:1 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9590
Practice Address - Country:US
Practice Address - Phone:609-924-0200
Practice Address - Fax:609-924-0201
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07262000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074646Medicare PIN
NJH49243Medicare UPIN