MEDICARE: DR. PRIYAM PATEL OD

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
1	152W00000X	Optometrist	27OA0063300	NJ

General Provider Information

NPI Number	:	1871872192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYAM PATEL OD

Provider Business Mailing Address
First Line	:	104 HICKORY CORNER RD
Second Line	:	SUITE 203
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2460
Country	:	US
Telephone Number	:	609-308-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 HICKORY CORNER RD
Second Line	:	SUITE 203
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2460
Country	:	US
Telephone Number	:	609-308-2850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	12/23/2013

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