Provider Demographics
NPI:1346526183
Name:JANSSEN, DANIEL J (RPA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 WALL ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12824-2513
Mailing Address - Country:US
Mailing Address - Phone:518-668-2450
Mailing Address - Fax:
Practice Address - Street 1:9 CAREY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-7880
Practice Address - Country:US
Practice Address - Phone:518-761-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015059-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant