Provider Demographics
NPI:1790956936
Name:PETERSEL, DANIELLE LAUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LAUREN
Last Name:PETERSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLUMBUS PL
Mailing Address - Street 2:S 8 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8201
Mailing Address - Country:US
Mailing Address - Phone:516-662-6565
Mailing Address - Fax:
Practice Address - Street 1:1 COLUMBUS PL
Practice Address - Street 2:S 8 D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-8201
Practice Address - Country:US
Practice Address - Phone:516-662-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232257-1207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology