1871031310 NPI number — MRS. DANIELLE MAEGHAN CONKLIN B.S, M.A

Table of content: MRS. DANIELLE MAEGHAN CONKLIN B.S, M.A (NPI 1871031310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871031310 NPI number — MRS. DANIELLE MAEGHAN CONKLIN B.S, M.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONKLIN
Provider First Name:
DANIELLE
Provider Middle Name:
MAEGHAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.S, M.A
Provider Gender Code:
F

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:
1871031310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 RIVERSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASTIC BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11951-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-875-8793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 AUSTIN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-4739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-762-7633
Provider Business Practice Location Address Fax Number:
718-886-8694
Provider Enumeration Date:
02/04/2017

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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