Healthcare Provider Details

I. General information

NPI: 1528209848
Provider Name (Legal Business Name): DANIEL JACOB MACHLEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 POST RD SUITE 202
FAIRFIELD CT
06824-6016
US

IV. Provider business mailing address

33 CHURCH HILL RD
NEWTOWN CT
06470-1637
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-2926
  • Fax: 203-292-6376
Mailing address:
  • Phone: 203-426-5554
  • Fax: 203-426-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number60261652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: