Basic Information
| Provider Information | |||||||||
| NPI: | 1730122649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | RAJEEV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 W GILBERT ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120051 | ||||||||
| FaxNumber: | 7322120713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ROBERT WOOD JOHNSON PL | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322355699 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 25MA07043800 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 221494442 | 01 | NJ | TAX ID # | OTHER | 60011743 | 01 | NJ | HORIZON NJ HEALTH ID # | OTHER | 8219773 | 01 | NJ | GHI PPO ID # | OTHER | 86559 | 01 | NJ | AMERICAID ID # | OTHER | P3191505 | 01 | NJ | OXFORD ID # | OTHER | 29404 | 01 | NJ | UNIVERSITY HP ID # | OTHER | 3416781 | 01 | NJ | AETNA HMO ID # | OTHER | 4453781 | 01 | NJ | AETNA PPO ID # | OTHER | 01000395001 | 01 | NJ | AMERICHOICE ID # | OTHER | 8226300 | 05 | NJ | MEDICAID |