MEDICARE: DANIEL SAGALOVICH M.D.

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	208800000X	Urology Physician	276468	NY

General Provider Information

NPI Number	:	1558620369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL SAGALOVICH M.D.

Provider Business Mailing Address
First Line	:	900 SOUTH AVE STE 103
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3428
Country	:	US
Telephone Number	:	718-226-6461
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SOUTH AVE STE 103
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3428
Country	:	US
Telephone Number	:	718-226-6461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	09/16/2021

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