1568651008 NPI number — DANIEL T ROOT, M.D.

Table of content: (NPI 1568651008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568651008 NPI number — DANIEL T ROOT, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL T ROOT, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568651008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7785 N STATE ST
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
LOWVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-376-5287
Provider Business Mailing Address Fax Number:
315-376-3228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7785 N STATE ST
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
LOWVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13367-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-376-5287
Provider Business Practice Location Address Fax Number:
315-376-3228
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEISS
Authorized Official First Name:
MARY LOU
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MGR
Authorized Official Telephone Number:
315-376-5269

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1649401 , 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: 01178936 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01178945 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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