Healthcare Provider Details

I. General information

NPI: 1790037919
Provider Name (Legal Business Name): DANIELLE GERMAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3299 HARBOR POINT RD
BALDWIN NY
11510-5140
US

IV. Provider business mailing address

3299 HARBOR POINT RD
BALDWIN NY
11510-5140
US

V. Phone/Fax

Practice location:
  • Phone: 516-652-0578
  • Fax: 718-821-5009
Mailing address:
  • Phone: 516-652-0578
  • Fax: 718-821-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE GERMAIN
Title or Position: MANAGEMENT
Credential: AAS IN ACCOUNTING
Phone: 516-652-0578