Provider Demographics
NPI:1063485969
Name:MASSIAH, DANIEL COLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:COLIN
Last Name:MASSIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1025 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2735
Mailing Address - Country:US
Mailing Address - Phone:631-727-6717
Mailing Address - Fax:631-953-0204
Practice Address - Street 1:1025 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2735
Practice Address - Country:US
Practice Address - Phone:631-727-6717
Practice Address - Fax:631-953-0204
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235602207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1861894OtherCIGNA
NY8V2021OtherBCBS
NY12388304OtherMULTIPLAN
NY8V044OtherBCBS
NYP00260961OtherRAILROAD MEDICARE
NY235602-0WOtherWORKER'S COMPENSATION
NY8V044OtherBCBS
NYI30251Medicare UPIN