Healthcare Provider Details

I. General information

NPI: 1124067046
Provider Name (Legal Business Name): DANIEL PAUL KREMIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 LUDDINGTON RD
EAST MEADOW NY
11554-4640
US

IV. Provider business mailing address

1479 LUDDINGTON ROAD
EAST MEADOW NY
11554
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-4066
  • Fax: 516-334-6222
Mailing address:
  • Phone: 516-333-4066
  • Fax: 516-334-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010582
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048 0000721
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 862
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number010582
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number048 0000721
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 862
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: