Provider Demographics
NPI:1083818785
Name:PATELLIS, NIKI (OD)
Entity Type:Individual
Prefix:DR
First Name:NIKI
Middle Name:
Last Name:PATELLIS
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 1:25 KINNELON RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2337
Mailing Address - Country:US
Mailing Address - Phone:973-838-8190
Mailing Address - Fax:973-838-3230
Practice Address - Street 1:25 KINNELON RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2337
Practice Address - Country:US
Practice Address - Phone:973-838-8190
Practice Address - Fax:973-838-3230
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00520400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2K5690OtherHEALTH NET
NJP00201344OtherRAILROAD MEDICARE
NJ2K5690OtherHEALTH NET
NJ0672440001Medicare NSC
NJU45268Medicare UPIN