Provider Demographics
NPI:1780624999
Name:JERAN, DANIEL (DPM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JERAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ROUTE 111
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4370
Mailing Address - Country:US
Mailing Address - Phone:631-979-7654
Mailing Address - Fax:631-979-4002
Practice Address - Street 1:521 ROUTE 111
Practice Address - Street 2:SUITE 309
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4370
Practice Address - Country:US
Practice Address - Phone:631-979-7654
Practice Address - Fax:631-979-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004563-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113102546001OtherTRICARE
NY470624OtherUSHC
NYCS641OtherOXFORD
NM003728OtherPHS
NY01635689Medicaid
NY00456301OtherSUFFOLK HEALTH PLAN
NY0941080001OtherMEDICARE DME
NYP50852OtherBCBS
NY10158OtherVYTRA
NY0021194OtherGHI
NY7720375006OtherCIGNA
NY108845Other108845
NY4343388OtherAETNA
NYANTHEMOther030004563NY01
NYP50852OtherBCBS
NYT90474Medicare UPIN