Provider Demographics
NPI:1033258835
Name:SEIDMAN, DANIEL F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:SEIDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3274
Mailing Address - Country:US
Mailing Address - Phone:646-259-0305
Mailing Address - Fax:212-305-1249
Practice Address - Street 1:1065 LEXINGTON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3274
Practice Address - Country:US
Practice Address - Phone:646-259-0305
Practice Address - Fax:212-305-1249
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010402-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV94932Medicare ID - Type UnspecifiedMEDICARE