Healthcare Provider Details

I. General information

NPI: 1649377375
Provider Name (Legal Business Name): DANIEL O'CONNOR MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
BROOKLYN NY
11201-5301
US

IV. Provider business mailing address

1 UNIVERSITY PLZ
BROOKLYN NY
11201-5301
US

V. Phone/Fax

Practice location:
  • Phone: 718-488-1521
  • Fax: 718-246-6392
Mailing address:
  • Phone: 718-488-1521
  • Fax: 718-246-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number338-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: