Provider Demographics
NPI:1821251745
Name:BORNSTEIN, DANIEL JOSEPH (IDC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:BORNSTEIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDING OFFICER DSO 2D MARDIV
Mailing Address - Street 2:PSC BOX 20003
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:FL
Mailing Address - Zip Code:28542-0003
Mailing Address - Country:US
Mailing Address - Phone:910-451-8290
Mailing Address - Fax:
Practice Address - Street 1:H1 JULIAN C SMITH
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:FL
Practice Address - Zip Code:28542-0003
Practice Address - Country:US
Practice Address - Phone:910-451-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman