Provider Demographics
NPI:1912147166
Name:DE FEO, DANIEL SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:DE FEO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:541 CEDAR HILL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2133
Mailing Address - Country:US
Mailing Address - Phone:551-815-1000
Mailing Address - Fax:551-815-1001
Practice Address - Street 1:541 CEDAR HILL AVE STE 2
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2133
Practice Address - Country:US
Practice Address - Phone:551-815-1000
Practice Address - Fax:551-815-1001
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003663A207P00000X, 207Q00000X
NJ25MB09244900207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine