Provider Demographics
NPI:1528413424
Name:DANESHVAR, DANIAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIAL
Middle Name:
Last Name:DANESHVAR
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 1:305 SEGUINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3709
Mailing Address - Country:US
Mailing Address - Phone:718-605-5000
Mailing Address - Fax:718-605-5004
Practice Address - Street 1:305 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3709
Practice Address - Country:US
Practice Address - Phone:718-605-5000
Practice Address - Fax:718-605-5004
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303928-01207RG0100X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program