Healthcare Provider Details

I. General information

NPI: 1295596674
Provider Name (Legal Business Name): MS. DANIELLE HUTHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 30TH ST RM 709
NEW YORK NY
10001-4068
US

IV. Provider business mailing address

200 E 66TH ST APT B205
NEW YORK NY
10065-9180
US

V. Phone/Fax

Practice location:
  • Phone: 917-935-9577
  • Fax:
Mailing address:
  • Phone: 917-935-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3771897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: