Healthcare Provider Details

I. General information

NPI: 1912140781
Provider Name (Legal Business Name): PAYAL PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 3RD AVE STE LL
NEW YORK NY
10016
US

IV. Provider business mailing address

436 3RD AVE STE LL
NEW YORK NY
10016-6025
US

V. Phone/Fax

Practice location:
  • Phone: 646-443-6061
  • Fax:
Mailing address:
  • Phone: 646-443-6061
  • Fax: 855-600-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number256484
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number256484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: