=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124825518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK DACO FAMILY HEALTH NP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 153 4TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11217-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-295-8988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 TERRACE AVE
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07644-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK V DACO
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 929-295-8988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------