Provider Demographics
NPI:1720207996
Name:GIRARDI, DANIEL (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GIRARDI
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 1:1992 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2701
Mailing Address - Country:US
Mailing Address - Phone:631-667-4444
Mailing Address - Fax:631-667-0601
Practice Address - Street 1:1992 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2701
Practice Address - Country:US
Practice Address - Phone:631-667-4444
Practice Address - Fax:631-667-0601
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003925-2213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0093679Medicaid
NYT51304Medicare UPIN
NY0093679Medicaid
NYP0632PBC72Medicare PIN