Healthcare Provider Details

I. General information

NPI: 1861499147
Provider Name (Legal Business Name): DANIEL ROBERT FOITL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E 58TH ST
NEW YORK NY
10022-2302
US

IV. Provider business mailing address

445 E 58TH ST
NEW YORK NY
10022-2302
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-0270
  • Fax: 212-753-5329
Mailing address:
  • Phone: 212-838-0270
  • Fax: 212-753-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number175720
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number175720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: