Healthcare Provider Details

I. General information

NPI: 1750898896
Provider Name (Legal Business Name): DANIEL KIKIROV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E RIDGEWOOD AVE # B
PARAMUS NJ
07652-3609
US

IV. Provider business mailing address

14105 PERSHING CRES APT 517
BRIARWOOD NY
11435-1907
US

V. Phone/Fax

Practice location:
  • Phone: 201-599-3366
  • Fax:
Mailing address:
  • Phone: 917-391-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03913700
License Number StateNJ

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: