Provider Demographics
NPI:1013623768
Name:NATANOV, DANIEL (NP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:NATANOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 139TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1602
Mailing Address - Country:US
Mailing Address - Phone:347-458-0395
Mailing Address - Fax:
Practice Address - Street 1:8311 139TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1602
Practice Address - Country:US
Practice Address - Phone:347-458-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily