Healthcare Provider Details

I. General information

NPI: 1659347110
Provider Name (Legal Business Name): DANIEL SCHLUSSELBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6243 WOODHAVEN BLVD
REGO PARK NY
11374-3731
US

IV. Provider business mailing address

105 SHELLEY CIR
MONSEY NY
10952-1444
US

V. Phone/Fax

Practice location:
  • Phone: 718-507-4700
  • Fax: 718-397-0422
Mailing address:
  • Phone: 845-362-0408
  • Fax: 845-362-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number144156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: