Healthcare Provider Details

I. General information

NPI: 1285603589
Provider Name (Legal Business Name): DANIEL C CAMILLERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 DOGWOOD AVE
FRANKLIN SQUARE NY
11010-3447
US

IV. Provider business mailing address

380 DOGWOOD AVE
FRANKLIN SQUARE NY
11010-3447
US

V. Phone/Fax

Practice location:
  • Phone: 516-481-3660
  • Fax: 516-481-1602
Mailing address:
  • Phone: 516-481-3660
  • Fax: 516-481-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: