Provider Demographics
NPI:1073160149
Name:JASPAL, MADHAVI (OD)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:JASPAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MADHAVI
Other - Middle Name:
Other - Last Name:UPPAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:125 KENNEDY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-257-5097
Practice Address - Street 1:100 MANETTO HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-935-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003202152W00000X
NY009184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist