Healthcare Provider Details

I. General information

NPI: 1720462385
Provider Name (Legal Business Name): DANIEL SCOTT TREISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/15/2024
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FOUNDERS PLZ
EAST HARTFORD CT
06108-3212
US

IV. Provider business mailing address

111 FOUNDERS PLZ
EAST HARTFORD CT
06108-3212
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-3375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA148703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: