Healthcare Provider Details

I. General information

NPI: 1477878130
Provider Name (Legal Business Name): PAYAL PATEL GHAYAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAYAL ANIL PATEL M.D.

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 ERIKA LN
UPLAND CA
91784-9277
US

IV. Provider business mailing address

1777 ERIKA LN
UPLAND CA
91784-9277
US

V. Phone/Fax

Practice location:
  • Phone: 201-919-2066
  • Fax:
Mailing address:
  • Phone: 201-919-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number256210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: