Provider Demographics
NPI:1003273194
Name:DANIEL G HERBOWY
Entity Type:Organization
Organization Name:DANIEL G HERBOWY
Other - Org Name:FUTSPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBOWY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-525-7087
Mailing Address - Street 1:208 BITTERN CT
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3516
Mailing Address - Country:US
Mailing Address - Phone:315-525-7087
Mailing Address - Fax:315-793-3149
Practice Address - Street 1:4340 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5316
Practice Address - Country:US
Practice Address - Phone:315-738-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002813332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1065540002OtherDMERC