Provider Demographics
NPI:1720183999
Name:PYO, DANIEL JINTAE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JINTAE
Last Name:PYO
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 1:131 MADISON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-540-9055
Mailing Address - Fax:973-540-0344
Practice Address - Street 1:131 MADISON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-540-9055
Practice Address - Fax:973-540-0344
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06570500208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023387OtherMEDICARE
NJ023387OtherMEDICARE