Healthcare Provider Details

I. General information

NPI: 1063451219
Provider Name (Legal Business Name): DANIEL W SKUPSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST # S365
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

5645 MAIN ST RM S365
FLUSHING NY
11355-5045
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1534
  • Fax: 718-661-7356
Mailing address:
  • Phone: 187-670-1534
  • Fax: 718-661-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number189071
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number189071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: