Provider Demographics
NPI:1942393152
Name:DURET, DANIELLE (MD)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:
Last Name:DURET
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 1:15 SECOR CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2841
Mailing Address - Country:US
Mailing Address - Phone:718-563-0757
Mailing Address - Fax:718-563-0756
Practice Address - Street 1:MMG - UNIVERSITY AVENUE
Practice Address - Street 2:105 WEST 188TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-563-0757
Practice Address - Fax:718-563-0756
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine