Provider Demographics
NPI:1881044295
Name:DENNIS, DANIEL THOMAS JR (FNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:THOMAS
Last Name:DENNIS
Suffix:JR
Gender:M
Credentials:FNP
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Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:PCC-MAIN, POB 6TH FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5491
Mailing Address - Fax:315-448-6203
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:PCC-MAIN, POB 6TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5491
Practice Address - Fax:315-448-6203
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-08-01
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Provider Licenses
StateLicense IDTaxonomies
NY340652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF340652-1OtherNEW YORK STATE LICENSE NUMBER