MEDICARE: PUJA PATEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV008817	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205362225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUJA PATEL O.D.

Provider Business Mailing Address
First Line	:	1729 BURRSTONE RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-1001
Country	:	US
Telephone Number	:	315-798-1730
Fax Number	:	315-798-1496

Provider Business Practice Location Address
First Line	:	1038 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459
Country	:	US
Telephone Number	:	718-328-7137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	11/11/2025

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