Provider Demographics
NPI:1720149651
Name:DANIEL, MYRTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRTA
Middle Name:
Last Name:DANIEL
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 1:136 JEATOM LN
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1611
Mailing Address - Country:US
Mailing Address - Phone:718-518-5550
Mailing Address - Fax:718-518-5111
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:BRONX LEBANON HOSPITAL - 3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5550
Practice Address - Fax:718-518-5111
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184490207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY248J81Medicare ID - Type UnspecifiedPROVIDER NUMBER