Healthcare Provider Details

I. General information

NPI: 1881300275
Provider Name (Legal Business Name): DANIELLE ZUMPOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE COLLINS

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WHITE PINE WAY
MEDFORD NY
11763-4215
US

IV. Provider business mailing address

71 WHITE PINE WAY
MEDFORD NY
11763-4215
US

V. Phone/Fax

Practice location:
  • Phone: 973-934-0695
  • Fax:
Mailing address:
  • Phone: 973-934-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number00294094
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00294094
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: