Provider Demographics
NPI:1336409366
Name:DANIEL, RALPH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:
Last Name:DANIEL
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1944
Mailing Address - Country:US
Mailing Address - Phone:718-434-1011
Mailing Address - Fax:718-434-4146
Practice Address - Street 1:3621 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1944
Practice Address - Country:US
Practice Address - Phone:718-434-1011
Practice Address - Fax:718-434-4146
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015587363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical