Healthcare Provider Details

I. General information

NPI: 1780909606
Provider Name (Legal Business Name): BRIAN DANIELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2010
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 TAUGHANNOCK BLVD
ITHACA NY
14850-3251
US

IV. Provider business mailing address

310 TAUGHANNOCK BLVD
ITHACA NY
14850-3251
US

V. Phone/Fax

Practice location:
  • Phone: 607-252-3580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberME138351
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number276592
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35992
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: