Provider Demographics
NPI:1023270055
Name:FAWAZ, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:FAWAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 79TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0321
Mailing Address - Country:US
Mailing Address - Phone:706-877-3720
Mailing Address - Fax:
Practice Address - Street 1:111 E 79TH ST
Practice Address - Street 2:APT A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0321
Practice Address - Country:US
Practice Address - Phone:706-877-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249131207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine