Provider Demographics
NPI:1639134885
Name:TROCK, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:TROCK
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 1:1150 YOUNGS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8053
Mailing Address - Country:US
Mailing Address - Phone:716-636-7979
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:1150 YOUNGS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8053
Practice Address - Country:US
Practice Address - Phone:716-636-7979
Practice Address - Fax:716-636-7993
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02174050Medicaid
NYDD0268Medicare ID - Type Unspecified
NYH44833Medicare UPIN