Basic Information
Provider Information
NPI: 1245664721
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: DANIEL
MiddleName: PHILIP
NamePrefix: MR.
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3085 HARLEM RD
Address2: SUITE 200
City: CHEEKTOWAGA
State: NY
PostalCode: 142252591
CountryCode: US
TelephoneNumber: 7168445000
FaxNumber: 7168445050
Practice Location
Address1: 3085 HARLEM RD
Address2: SUITE 200
City: CHEEKTOWAGA
State: NY
PostalCode: 142252591
CountryCode: US
TelephoneNumber: 7168445000
FaxNumber: 7168445050
Other Information
ProviderEnumerationDate: 09/03/2013
LastUpdateDate: 09/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X016888NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


Home