1043479090 NPI number — DR. DANIEL ETHAN BOXER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043479090 NPI number — DR. DANIEL ETHAN BOXER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOXER
Provider First Name:
DANIEL
Provider Middle Name:
ETHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1043479090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 CEDAR STREET, YALE MEDICAL SCHOOL
Provider Second Line Business Mailing Address:
WWW205
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-845-4811
Provider Business Mailing Address Fax Number:
203-845-4897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 PARK AVENUE
Provider Second Line Business Practice Location Address:
GARDEN LEVEL
Provider Business Practice Location Address City Name:
TRUMBALL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-502-8400
Provider Business Practice Location Address Fax Number:
203-845-4897
Provider Enumeration Date:
06/05/2008

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: 207RH0003X , with the licence number:  56291 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00773616 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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