Provider Demographics
NPI:1164452413
Name:NIJENSOHN, DANIEL EDGARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDGARDO
Last Name:NIJENSOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5445
Mailing Address - Country:US
Mailing Address - Phone:203-336-3303
Mailing Address - Fax:203-336-5802
Practice Address - Street 1:340 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5445
Practice Address - Country:US
Practice Address - Phone:203-336-3303
Practice Address - Fax:203-336-5802
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18224207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38239Medicare UPIN