Provider Demographics
NPI:1164830881
Name:MISTRY, RUPALI (OD)
Entity Type:Individual
Prefix:
First Name:RUPALI
Middle Name:
Last Name:MISTRY
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 1:550 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:732-287-6600
Mailing Address - Fax:
Practice Address - Street 1:550 OLD POST RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4861
Practice Address - Country:US
Practice Address - Phone:732-287-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00653600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist