Provider Demographics
NPI:1598766206
Name:DAVIES, DANIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2722
Mailing Address - Country:US
Mailing Address - Phone:631-581-8828
Mailing Address - Fax:631-581-0545
Practice Address - Street 1:252 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2722
Practice Address - Country:US
Practice Address - Phone:631-581-8828
Practice Address - Fax:631-581-0545
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004378213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1487963880OtherORGANIZATION-DMERC
NY011089388Medicaid
NY1003082884OtherDMERC NPI
NYP49711OtherPTAN
P49712Medicare ID - Type Unspecified
NYP49711OtherPTAN