Healthcare Provider Details

I. General information

NPI: 1821330218
Provider Name (Legal Business Name): DANIEL ROSS MUSIKANTOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH AVE
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

150 E 42ND ST FL 9
NEW YORK NY
10017-5699
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax: 212-410-7196
Mailing address:
  • Phone: 646-605-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number308651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: