Provider Demographics
NPI:1770003212
Name:PATEL, PRIYA P (OD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:P
Last Name:PATEL
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 1:2206 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1832
Mailing Address - Country:US
Mailing Address - Phone:516-794-4816
Mailing Address - Fax:
Practice Address - Street 1:1044 NORTHERN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1507
Practice Address - Country:US
Practice Address - Phone:516-365-4500
Practice Address - Fax:516-365-6580
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT008597152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management