Healthcare Provider Details

I. General information

NPI: 1528264215
Provider Name (Legal Business Name): JAYRAG A PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALNUT ST STE L30
PHILADELPHIA PA
19106
US

IV. Provider business mailing address

216 MILL ST
BRISTOL PA
19007-4809
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-6402
  • Fax: 215-925-0262
Mailing address:
  • Phone: 215-781-2020
  • Fax: 215-788-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA08472100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number244576
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD433857
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: