Philip Modayil, M.D

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

NY127026 Issued in NY

Practice address

208 Roanoke Ave
Riverhead, NY 11901-2706

Phone

(631) 369-0104

Fax

(631) 369-5433

NPI assigned

Apr 8, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Service League, Inc.

  • Community/Behavioral Health Agency
  • Huntington, NY
  • NPI 1528093242
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1447423769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 PARK AVE",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117434516",
            "telephone_number": "631-427-3700",
            "fax_number": "631-427-0287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012706",
            "telephone_number": "631-369-0104",
            "fax_number": "631-369-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODAYIL",
        "first_name": "PHILIP",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-08",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "NY127026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00659412",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Farhaj Mirza, D.M.D.
• Mitchell S. Meyerson, MD, PC
• Lynn D Mitchell, NP
• Gabrielle Mizrahi, PHYSICIAN ASSISTANT
• MJD Optical Corp
• Eloise L Mogel, RDH
• Jessica Mojica
• Laura Jeanne Molden, LCSW
• Michelle Molina
• Edward McCormack Molloy, RN

• Psychiatry Physician in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.