Provider Demographics
NPI:1619947066
Name:ENRIQUEZ, DANILO A (MD)
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:A
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 SUFFOLK PL
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3032
Mailing Address - Country:US
Mailing Address - Phone:631-940-1120
Mailing Address - Fax:631-940-3109
Practice Address - Street 1:1545 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:631-940-1120
Practice Address - Fax:631-940-3109
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY200191207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666779Medicaid
NY01666779Medicaid
NYG14131Medicare UPIN