Provider Demographics
NPI:1760891352
Name:UNVERZAGT, DANIEL (MS, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:UNVERZAGT
Suffix:
Gender:M
Credentials:MS, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:914-522-7164
Mailing Address - Fax:
Practice Address - Street 1:300 STEAMBOAT RD.
Practice Address - Street 2:
Practice Address - City:KINGS POINT
Practice Address - State:NY
Practice Address - Zip Code:11024
Practice Address - Country:US
Practice Address - Phone:516-726-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0011322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer