Provider Demographics
NPI:1225025687
Name:DAIELLO, ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DAIELLO
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 1:25 ULSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-1212
Mailing Address - Country:US
Mailing Address - Phone:845-246-3642
Mailing Address - Fax:845-246-1612
Practice Address - Street 1:25 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-1212
Practice Address - Country:US
Practice Address - Phone:845-246-3642
Practice Address - Fax:845-246-1612
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62571Medicare UPIN
NYQN6041Medicare ID - Type Unspecified