Provider Demographics
NPI:1376533356
Name:ROOT, DANIEL TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TIMOTHY
Last Name:ROOT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7785 N STATE ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1229
Mailing Address - Country:US
Mailing Address - Phone:315-376-5287
Mailing Address - Fax:315-376-3228
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5287
Practice Address - Fax:315-376-3228
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2013-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1649401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178945Medicaid
NY01178945Medicaid
NY52065BMedicare ID - Type UnspecifiedMEDICARE