Healthcare Provider Details

I. General information

NPI: 1043479090
Provider Name (Legal Business Name): DANIEL ETHAN BOXER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 01/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 PARK AVENUE GARDEN LEVEL
TRUMBALL CT
06611
US

IV. Provider business mailing address

333 CEDAR STREET, YALE MEDICAL SCHOOL WWW205
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-502-8400
  • Fax: 203-845-4897
Mailing address:
  • Phone: 203-845-4811
  • Fax: 203-845-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number56291
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: