Healthcare Provider Details

I. General information

NPI: 1578628160
Provider Name (Legal Business Name): DANIEL LEWIS ZEIDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAMPLIN AVE UTICA PEDIATRICS
UTICA NY
13502-3662
US

IV. Provider business mailing address

1450 CHAMPLIN AVE
UTICA NY
13502-3662
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-7909
  • Fax: 315-793-9307
Mailing address:
  • Phone: 315-732-7909
  • Fax: 315-793-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number174688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: