Provider Demographics
NPI:1518959204
Name:DRISCOLL, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2558
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:66 JOHNSON HILL RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:NY
Practice Address - Zip Code:13797-1403
Practice Address - Country:US
Practice Address - Phone:607-692-3844
Practice Address - Fax:607-692-3846
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00491447Medicaid
NY00491447Medicaid
NYB81381Medicare UPIN