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General NPI Number Information
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NPI Number | 1982047916
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Entity Type | Organization
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Legal Business Name | DALTON OPEN MRI, P.C.
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 20416 HILLSIDE AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2217
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Country | US
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Telephone | 718-776-1625
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Fax | 718-776-1593
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Provider Business Mailing Address
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Address Line | 20416 HILLSIDE AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2217
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Country | US
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Telephone | 718-776-1625
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Fax | 718-776-1593
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALTON R. DANIEL
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Credential | M.D.
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Telephone | 718-966-6019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200099-1
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License Number State | NY
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