Healthcare Provider Details

I. General information

NPI: 1942147186
Provider Name (Legal Business Name): DANIELLA KLARA MAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 SEAVIEW AVE
STATEN ISLAND NY
10305-2200
US

IV. Provider business mailing address

244 MONTREAL AVE
STATEN ISLAND NY
10306-3910
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6110
  • Fax:
Mailing address:
  • Phone: 845-263-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: