Provider Demographics
NPI:1306858857
Name:DANIEL L MAYER MD PC
Entity Type:Organization
Organization Name:DANIEL L MAYER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-366-5252
Mailing Address - Street 1:263 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-366-5252
Mailing Address - Fax:631-366-4371
Practice Address - Street 1:263 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-366-5252
Practice Address - Fax:631-366-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1400451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY140045B10OtherHEALTHFIRST
NY72F301OtherEMPIRE BC BS
NY0748519OtherAETNA
NY6C5498OtherHEALTHNET
NYCP039OtherOXFORD HEALTH PLANS
NY2238OtherVYTRA HEALTH PLANS
NY00603338Medicaid
NY26823POtherHIP
NY6C5498OtherHEALTHNET
NY2238OtherVYTRA HEALTH PLANS