Healthcare Provider Details

I. General information

NPI: 1043235435
Provider Name (Legal Business Name): DANIEL E KOBLENTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 MAIN ST
PEEKSKILL NY
10566-2913
US

IV. Provider business mailing address

1200 BROWN ST CREDENTIALING DEPT.
PEEKSKILL NY
10566-3617
US

V. Phone/Fax

Practice location:
  • Phone: 914-734-8800
  • Fax: 914-734-8808
Mailing address:
  • Phone: 914-734-8858
  • Fax: 914-734-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number110977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: