MEDICARE: NOOPUR MODI

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	27OA00738400	NJ

General Provider Information

NPI Number	:	1205716248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOOPUR MODI

Provider Business Mailing Address
First Line	:	106 CAMPBELL AVE APT 2
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-2825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GARDEN STATE PLZ UNIT 1105
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-5805
Country	:	US
Telephone Number	:	201-793-7814
Fax Number	:

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

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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Directions to “ NOOPUR MODI ” Practice Location

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