Provider Demographics
NPI:1972115566
Name:PATEL, PAYAL P (OD)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
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 1:1225 MCBRIDE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3813
Mailing Address - Country:US
Mailing Address - Phone:973-785-2050
Mailing Address - Fax:
Practice Address - Street 1:1225 MCBRIDE AVE STE 204
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3813
Practice Address - Country:US
Practice Address - Phone:973-785-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00697100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist