MEDICARE: DANIELLE M. PHILLIPS MD P.C.

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	174400000X	Specialist	229021	NY

General Provider Information

NPI Number	:	1427455864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELLE M. PHILLIPS MD P.C.

Provider Business Mailing Address
First Line	:	1917 BEDFORD AVE
Second Line	:	GROUND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5306
Country	:	US
Telephone Number	:	718-469-1900
Fax Number	:	718-469-1902

Provider Business Practice Location Address
First Line	:	1917 BEDFORD AVE
Second Line	:	GROUND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5306
Country	:	US
Telephone Number	:	718-469-1900
Fax Number	:	718-469-1902

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DANIELLE PHILLIPS
Credential	:	MSD
Telephone Number	:	718-469-1900

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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