Healthcare Provider Details

I. General information

NPI: 1265847511
Provider Name (Legal Business Name): DANIEL MOKSZYCKI MD, PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOTT ST STE 106
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

1201 NOTT ST STE 106
SCHENECTADY NY
12308-2589
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-3123
  • Fax:
Mailing address:
  • Phone: 518-374-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059204
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64197
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number320092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: