Provider Demographics
NPI:1568422913
Name:BOCCARDO, DANIEL ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANTONIO
Last Name:BOCCARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 43RD ST
Mailing Address - Street 2:#211
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4822
Mailing Address - Country:US
Mailing Address - Phone:212-922-9302
Mailing Address - Fax:718-424-4868
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4590
Practice Address - Country:US
Practice Address - Phone:718-424-0339
Practice Address - Fax:718-424-4868
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130526207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01103497Medicaid
NY01103497Medicaid
NY07484HMedicare PIN
20F381Medicare PIN