Provider Demographics
NPI:1093090524
Name:ZWILLENBERG, DANIEL P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:ZWILLENBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N BROADWAY STE 912
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2322
Mailing Address - Country:US
Mailing Address - Phone:914-385-1150
Mailing Address - Fax:914-385-1155
Practice Address - Street 1:645 W 239TH ST
Practice Address - Street 2:APT 5B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1234
Practice Address - Country:US
Practice Address - Phone:484-889-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019299103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral