Healthcare Provider Details

I. General information

NPI: 1487963880
Provider Name (Legal Business Name): DANIEL DAVIES, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2010
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 E MAIN ST
EAST ISLIP NY
11730-2722
US

IV. Provider business mailing address

252 E MAIN ST
EAST ISLIP NY
11730-2722
US

V. Phone/Fax

Practice location:
  • Phone: 631-581-8828
  • Fax: 631-581-0545
Mailing address:
  • Phone: 631-581-8828
  • Fax: 631-581-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN004378
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberN004378
License Number StateNY

VIII. Authorized Official

Name: DANIEL A DAVIES
Title or Position: SOLE PROPRIETOR
Credential: DPM
Phone: 631-581-8828