Provider Demographics
NPI:1346298338
Name:CLEARY, DANIEL G
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:CLEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:1182 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-713-5400
Practice Address - Fax:518-713-5401
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333566363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ16943Medicare UPIN