MEDICARE: DANIEL DAVIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	N004378	NY

General Provider Information

NPI Number	:	1336693985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL DAVIES

Provider Business Mailing Address
First Line	:	252 E MAIN ST
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-2722
Country	:	US
Telephone Number	:	631-581-8828
Fax Number	:	631-581-0545

Provider Business Practice Location Address
First Line	:	252 E MAIN ST
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-2722
Country	:	US
Telephone Number	:	631-581-8828
Fax Number	:	631-581-0545

Authorized Official
Title or Position	:	OWNER/PODIATRIST
Name	:	DANIEL DAVIES
Credential	:	DPM
Telephone Number	:	631-581-8828

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	12/02/2016

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1487963880 — DANIEL DAVIES, DPM
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Directions to “DANIEL DAVIES ” Practice Location

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