Individual
SAMANTHA MEHTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
47 COACHLIGHT DR, SICKLERVILLE, NJ 08081-5606
(609) 220-6421
Mailing address
47 COACHLIGHT DR, SICKLERVILLE, NJ 08081-5606
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00715600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TQJ4047604901
INDEPENDENCE BLUE CROSS PERSONAL CHOICE
NJ
Enumeration date
05/29/2014
Last updated
05/29/2014
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