Healthcare Provider Details

I. General information

NPI: 1194811257
Provider Name (Legal Business Name): IERACHMIEL Y. DASKAL M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD TOWER GRD FL
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

101 E OLNEY AVE SUITE 505
PHILADELPHIA PA
19120-2421
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6157
  • Fax: 215-456-6426
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberMD030423E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: