# PRIYA MOHANTY MEDICAL PRACTICE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104134048
- **Authorized official:** PRIYA D. MOHANTY M.D. (PRESIDENT)
- **Authorized official phone:** (716) 238-1782

## Contact information

- **Practice address:** 2626 W STATE ST, STE \# 208, OLEAN, NY 14760-1858
- **Practice address phone:** (716) 790-8038
- **Practice address fax:** (716) 790-8041
- **Mailing address:** 2626 W STATE ST, STE \# 208, OLEAN, NY 14760-1858
- **Mailing address phone:** (716) 790-8038
- **Mailing address fax:** (716) 790-8041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 224111 | NY | Yes |

## Other

- **Enumeration date:** 09/14/2010
- **Last updated:** 07/16/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02319928 | — | NY |
| 05 | — | 1021088750001 | — | PA |
| 01 | — | 1194712695 | INDIVIDUAL NPI | — |