Provider Demographics
NPI:1336345461
Name:DALY, JEANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:
Last Name:DALY
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 1:41 RIVER TER
Mailing Address - Street 2:#1403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1113
Mailing Address - Country:US
Mailing Address - Phone:917-596-3338
Mailing Address - Fax:
Practice Address - Street 1:12 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1417
Practice Address - Country:US
Practice Address - Phone:973-376-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233484207N00000X
NJ25MA08646500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology