Healthcare Provider Details

I. General information

NPI: 1487902722
Provider Name (Legal Business Name): DANIEL VAN METER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

475 MAIN ST APT. 12 Q
NEW YORK NY
10044-0085
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-7155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number033.0003817
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number053108
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: