1770672701 NPI number — MR. DANIEL GLENN FORSBERG P.A.-C

Table of content: MR. DANIEL GLENN FORSBERG P.A.-C (NPI 1770672701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770672701 NPI number — MR. DANIEL GLENN FORSBERG P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORSBERG
Provider First Name:
DANIEL
Provider Middle Name:
GLENN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
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:
1770672701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 RXR PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11556-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-453-0435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11576-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-621-1313
Provider Business Practice Location Address Fax Number:
516-621-0116
Provider Enumeration Date:
10/11/2006

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: 363AM0700X , with the licence number:  003030 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 003030 , 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)





Copyright © 2007-2024 www.npivalidator.com