Healthcare Provider Details

I. General information

NPI: 1245247527
Provider Name (Legal Business Name): DANIEL J ZEIDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BEACH 95TH ST
ROCKAWAY BEACH NY
11693-1303
US

IV. Provider business mailing address

92 MARGARET AVE
LAWRENCE NY
11559-1826
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-9384
  • Fax: 718-318-8866
Mailing address:
  • Phone: 516-239-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: