Provider Demographics
NPI:1518965441
Name:DALY, THEODORE J (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:DALY
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 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-227-3377
Mailing Address - Fax:516-227-3378
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-227-3377
Practice Address - Fax:516-227-3378
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-02-16
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NY176620173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE44644Medicare UPIN