Provider Demographics
NPI:1508969106
Name:DANZ, WILLIAM RANDALL
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RANDALL
Last Name:DANZ
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 1:347 5TH AVE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5010
Mailing Address - Country:US
Mailing Address - Phone:212-697-5722
Mailing Address - Fax:212-687-9185
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:SUITE 1104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:212-697-5722
Practice Address - Fax:212-687-9185
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00342434Medicaid
NY0226940001Medicare ID - Type Unspecified