Provider Demographics
NPI:1811007040
Name:FINEGAN, DANIEL EDWARD (PAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:FINEGAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 N OCEAN BLVD
Mailing Address - Street 2:APT 1607
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4641
Mailing Address - Country:US
Mailing Address - Phone:845-774-6838
Mailing Address - Fax:
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE E2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-498-8891
Practice Address - Fax:561-498-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ58957Medicare UPIN
FLU6584AMedicare ID - Type Unspecified