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NPI Code Detail

MEDICARE: DR. DANIEL JAY PODBERESKY M.D.

MEDICARE: DR. DANIEL JAY PODBERESKY 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
12085P0229XPediatric Radiology PhysicianC10011071DE
22085P0229XPediatric Radiology PhysicianL9429TX
32085P0229XPediatric Radiology PhysicianME120711FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740268077
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL JAY PODBERESKY M.D.
Provider Business Mailing Address
First Line : PO BOX 191
Second Line :
City : ROCKLAND
State : DE
Zip : 19732-0191
Country : US
Telephone Number : 302-651-6212
Fax Number : 302-651-4945
Provider Business Practice Location Address
First Line : 6535 NEMOURS PKWY
Second Line :
City : ORLANDO
State : FL
Zip : 32827-7884
Country : US
Telephone Number : 407-567-4000
Fax Number : 407-567-5924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 09/15/2020

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