Healthcare Provider Details

I. General information

NPI: 1811230444
Provider Name (Legal Business Name): DANIEL OWENS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

100 CORPORATE DR
YONKERS NY
10701-6807
US

V. Phone/Fax

Practice location:
  • Phone: 914-378-6021
  • Fax:
Mailing address:
  • Phone: 917-378-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: