Provider Demographics
NPI:1871872192
Name:PATEL, PRIYAM (OD)
Entity type:Individual
Prefix:DR
First Name:PRIYAM
Middle Name:
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 1:104 HICKORY CORNER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2460
Mailing Address - Country:US
Mailing Address - Phone:609-308-2850
Mailing Address - Fax:
Practice Address - Street 1:104 HICKORY CORNER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2460
Practice Address - Country:US
Practice Address - Phone:609-308-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA0063300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist