Provider Demographics
NPI:1134277619
Name:MAENNER, DANIEL W (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:MAENNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1620
Mailing Address - Country:US
Mailing Address - Phone:201-869-6220
Mailing Address - Fax:
Practice Address - Street 1:6310 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1620
Practice Address - Country:US
Practice Address - Phone:201-869-6220
Practice Address - Fax:201-869-5145
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00505000111N00000X
390200000X
NJ25MB10577900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU72624Medicare UPIN
NJ021032Medicare PIN