Provider Demographics
NPI:1629196167
Name:DANIEL, BRIAN PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PETER
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 ROUTE 36 STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1306
Mailing Address - Country:US
Mailing Address - Phone:732-222-3805
Mailing Address - Fax:
Practice Address - Street 1:655 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4179
Practice Address - Country:US
Practice Address - Phone:203-915-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011693207L00000X
NJ25MB08537400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology