Provider Demographics
NPI:1437129293
Name:LAIETA, DANIEL J (D:O, FACP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:LAIETA
Suffix:
Gender:M
Credentials:D:O, FACP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HOLBROOK INTERNAL MEDICINE, PC
Mailing Address - Street 2:PO BOX 82
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792
Mailing Address - Country:US
Mailing Address - Phone:631-676-2542
Mailing Address - Fax:631-676-2543
Practice Address - Street 1:900 MAIN ST.
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-676-2542
Practice Address - Fax:631-676-2543
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY230975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIO3636Medicare UPIN