1629030150 NPI number — DR. BRUCE M DALY D.P.M

Table of content: DR. BRUCE M DALY D.P.M (NPI 1629030150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629030150 NPI number — DR. BRUCE M DALY D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALY
Provider First Name:
BRUCE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629030150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOPERSTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13326-0725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-547-3909
Provider Business Mailing Address Fax Number:
607-547-6325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ATWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-3909
Provider Business Practice Location Address Fax Number:
607-547-6325
Provider Enumeration Date:
04/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N004649 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01158438 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".