Healthcare Provider Details

I. General information

NPI: 1073160149
Provider Name (Legal Business Name): MADHAVI JASPAL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADHAVI UPPAL

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD STE 202
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

125 KENNEDY DR STE 400
HAUPPAUGE NY
11788-4017
US

V. Phone/Fax

Practice location:
  • Phone: 516-935-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax: 631-257-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003202
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009184
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: