Healthcare Provider Details

I. General information

NPI: 1467744789
Provider Name (Legal Business Name): DANIELLE REGISTRE OPAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26429 60TH RD
LITTLE NECK NY
11362-2541
US

IV. Provider business mailing address

26429 60TH RD
LITTLE NECK NY
11362-2541
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-8314
  • Fax: 718-276-8666
Mailing address:
  • Phone: 718-224-8314
  • Fax: 718-276-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number181627
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number181627
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number181627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: