Provider Demographics
NPI:1508206871
Name:DANIEL, RENY RAJAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RENY
Middle Name:RAJAN
Last Name:DANIEL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3400 BAINBRIDGE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:845-558-5457
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-4646
Practice Address - Fax:718-405-9014
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2015-03-22
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Provider Licenses
StateLicense IDTaxonomies
NY016583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant