Healthcare Provider Details

I. General information

NPI: 1033284377
Provider Name (Legal Business Name): DANIEL ARENAS JR. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

815 FOX ST APT 1A
BRONX NY
10459-5150
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4709
  • Fax:
Mailing address:
  • Phone: 718-860-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05020
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: