Provider Demographics
NPI:1861596298
Name:SHAH-MEHTA, NEHA (OD)
Entity type:Individual
Prefix:MRS
First Name:NEHA
Middle Name:
Last Name:SHAH-MEHTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3422
Mailing Address - Country:US
Mailing Address - Phone:212-683-7330
Mailing Address - Fax:212-683-1947
Practice Address - Street 1:220 MADISON AVE
Practice Address - Street 2:ROSENBLUM EYE CENTERS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3422
Practice Address - Country:US
Practice Address - Phone:212-683-7330
Practice Address - Fax:212-683-1947
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWOD801Medicare ID - Type Unspecified