Provider Demographics
NPI:1346598000
Name:DANANBERG, IRA (BC-HIS)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:DANANBERG
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MAIN ST.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5435
Mailing Address - Country:US
Mailing Address - Phone:718-445-3333
Mailing Address - Fax:718-445-6794
Practice Address - Street 1:3901 MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5432
Practice Address - Country:US
Practice Address - Phone:718-445-3333
Practice Address - Fax:718-445-6794
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment