Provider Demographics
NPI:1346582236
Name:ROUSSEAU, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROUSSEAU
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 1:147 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1806
Mailing Address - Country:US
Mailing Address - Phone:917-736-5332
Mailing Address - Fax:
Practice Address - Street 1:147 HOBART STREET
Practice Address - Street 2:
Practice Address - City:RIDGIEFIEL PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660
Practice Address - Country:US
Practice Address - Phone:917-736-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse