Healthcare Provider Details

I. General information

NPI: 1598766206
Provider Name (Legal Business Name): DANIEL DAVIES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
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 Code213E00000X
TaxonomyPodiatrist
License NumberN004378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: