=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972878379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL THOMAS MCGOVERN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2012
-----------------------------------------------------
Last Update Date | 04/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 397 BRIDGE ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-5292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-426-6886
-----------------------------------------------------
Fax | 423-301-8986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 W 86TH ST APT 15A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-4072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-426-6886
-----------------------------------------------------
Fax | 423-301-8986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 282670
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------