1063867687 NPI number — MR. DANIEL ANERTEY ABBEY SR.

Table of content: MR. DANIEL ANERTEY ABBEY SR. (NPI 1063867687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063867687 NPI number — MR. DANIEL ANERTEY ABBEY SR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBEY
Provider First Name:
DANIEL
Provider Middle Name:
ANERTEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
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:
1063867687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CENTRAL AVE
Provider Second Line Business Mailing Address:
SAINT MICHAEL MEDICAL CENTER, MEDICAL EDUCATION BUILDIN
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07102-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-877-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 EILEEN WAY UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYOSSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11791-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-855-5255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: P106558 , 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)





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