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General NPI Number Information
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NPI Number | 1467679472
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Entity Type | Organization
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Legal Business Name | INDRA D. DANIELS PHYSICIAN PLLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 2000 N. VILLAGE AVE SUITE 314
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570
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Country | US
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Telephone | 516-255-4200
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Fax | 516-594-2623
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Provider Business Mailing Address
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Address Line | 1315 BROADWAY UNIT B SUITE 120
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City | HEWLETT
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State | NY
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Zip | 11557
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Country | US
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Telephone | 516-255-4200
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Fax | 516-594-2623
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Authorized Official
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Title or Position | OWNER
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Name | DR. INDRA D. DANIELS
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Credential | PHYSICIAN PLLC
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Telephone | 516-255-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 187876
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License Number State | NY
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