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NPI Code Detail

MEDICARE: PHILIP MODAYIL M.D

MEDICARE: PHILIP MODAYIL M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianNY127026NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447423769
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP MODAYIL M.D
Provider Business Mailing Address
First Line : 790 PARK AVE
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4516
Country : US
Telephone Number : 631-427-3700
Fax Number : 631-427-0287
Provider Business Practice Location Address
First Line : 208 ROANOKE AVE
Second Line :
City : RIVERHEAD
State : NY
Zip : 11901-2706
Country : US
Telephone Number : 631-369-0104
Fax Number : 631-369-5433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2008
Last Update Date : 04/08/2008

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Directions to “ PHILIP MODAYIL M.D” Practice Location

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