Healthcare Provider Details

I. General information

NPI: 1699087148
Provider Name (Legal Business Name): PRIYADARSHAN BAJPAYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 MERRICK RD STE 300
MASSAPEQUA NY
11758-6238
US

IV. Provider business mailing address

5550 MERRICK RD STE 300
MASSAPEQUA NY
11758-6238
US

V. Phone/Fax

Practice location:
  • Phone: 631-673-3233
  • Fax: 631-673-1314
Mailing address:
  • Phone: 631-673-3233
  • Fax: 631-673-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number258077
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number258077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: