Healthcare Provider Details

I. General information

NPI: 1073686721
Provider Name (Legal Business Name): CELEENAMMA DANIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/05/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1111 AMSTERDAM AVE
NEW YORK NY
10025-1716
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6745
  • Fax:
Mailing address:
  • Phone: 212-523-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number187546
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number187546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: