=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285603589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL C CAMILLERY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 DOGWOOD AVE
-----------------------------------------------------
City | FRANKLIN SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11010-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-481-3660
-----------------------------------------------------
Fax | 516-481-1602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 DOGWOOD AVE
-----------------------------------------------------
City | FRANKLIN SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11010-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-481-3660
-----------------------------------------------------
Fax | 516-481-1602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 212795
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------