Healthcare Provider Details

I. General information

NPI: 1841264561
Provider Name (Legal Business Name): DANIEL DORAN DENNETT MS,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 ROUTE 9
MECHANICVILLE NY
12118-3024
US

IV. Provider business mailing address

11 MOORWOOD DR
QUEENSBURY NY
12804-1110
US

V. Phone/Fax

Practice location:
  • Phone: 518-899-0022
  • Fax:
Mailing address:
  • Phone: 518-798-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number001141-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number001141-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: