Provider Demographics
NPI:1164630992
Name:MERLIS, DANIELE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELE
Middle Name:
Last Name:MERLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 AUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1401
Mailing Address - Country:US
Mailing Address - Phone:917-692-7420
Mailing Address - Fax:
Practice Address - Street 1:366 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2737
Practice Address - Country:US
Practice Address - Phone:917-692-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219333208000000X
NJ25MA09831300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics