Healthcare Provider Details

I. General information

NPI: 1760914006
Provider Name (Legal Business Name): DANIEL SCALISE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

3331 BAINBRIDGE AVE
BRONX NY
10467-2801
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-0600
  • Fax:
Mailing address:
  • Phone: 718-920-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number306585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: