Provider Demographics
NPI:1780645473
Name:DANIAS, JOHN (MD,PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DANIAS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 HICKS STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-780-2600
Mailing Address - Fax:718-780-2601
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 78
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-780-2600
Practice Address - Fax:718-780-2601
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204603207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877985Medicaid
NY95T851Medicare ID - Type Unspecified
NY01877985Medicaid