Healthcare Provider Details

I. General information

NPI: 1457935843
Provider Name (Legal Business Name): DANIEL ALEXANDER ESIKOFF LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 25A
SMITHTOWN NY
11787-1398
US

IV. Provider business mailing address

PO BOX 430
EAST SETAUKET NY
11733-0430
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3791
  • Fax:
Mailing address:
  • Phone: 651-402-9486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: