Provider Demographics
NPI:1487963880
Name:DANIEL DAVIES, DPM
Entity type:Organization
Organization Name:DANIEL DAVIES, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-581-8828
Mailing Address - Street 1:252 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2722
Mailing Address - Country:US
Mailing Address - Phone:631-581-8828
Mailing Address - Fax:631-581-0545
Practice Address - Street 1:252 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2722
Practice Address - Country:US
Practice Address - Phone:631-581-8828
Practice Address - Fax:631-581-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004378332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01108938-8Medicaid
NY1003082884OtherDMERC
NY01108938-8Medicaid
NY1598766206Medicare PIN