Healthcare Provider Details

I. General information

NPI: 1902410913
Provider Name (Legal Business Name): DANIELLE TAPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE BURNS

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 RINGWOOD AVE
HASKELL NJ
07420-1408
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 973-616-9700
  • Fax: 973-616-9760
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01946200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT031391
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: