Provider Demographics
NPI:1932308871
Name:DANIEL HAFNER PHYSICIAN PC
Entity Type:Organization
Organization Name:DANIEL HAFNER PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-331-6169
Mailing Address - Street 1:63 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2832
Mailing Address - Country:US
Mailing Address - Phone:845-331-6169
Mailing Address - Fax:845-331-0681
Practice Address - Street 1:63 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2832
Practice Address - Country:US
Practice Address - Phone:845-331-6169
Practice Address - Fax:845-331-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00211541Medicaid
NYWBW981Medicare PIN
NYB16626Medicare UPIN