Provider Demographics
NPI:1093772428
Name:HUNINK, DARRELL GEORGE (PT)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:GEORGE
Last Name:HUNINK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOOPER RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1560
Mailing Address - Country:US
Mailing Address - Phone:607-748-7890
Mailing Address - Fax:
Practice Address - Street 1:800 HOOPER RD
Practice Address - Street 2:SUITE 330
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1560
Practice Address - Country:US
Practice Address - Phone:607-748-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014228208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07418Medicare UPIN
NYRB0493Medicare PIN