MEDICARE: DR. DANIEL B. GOLLIN M.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	2084P0800X	Psychiatry Physician	225019	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2165N1	OTHER	NY	PROVIDER ID#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427098573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL B. GOLLIN M.D.

Provider Business Mailing Address
First Line	:	351 BELGROVE DR
Second Line	:	APT. 2
City	:	KEARNY
State	:	NJ
Zip	:	07032-1626
Country	:	US
Telephone Number	:	201-991-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	BOX 1228
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-241-3619
Fax Number	:	212-289-4096

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/15/2008

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Directions to “ DR. DANIEL B. GOLLIN M.D.” Practice Location

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