Basic Information
| Provider Information | |||||||||
| NPI: | 1417397332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGELBERG | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 MAIN ST APT 14 | ||||||||
| Address2: | |||||||||
| City: | FARMINGDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117356513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318825853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117724870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316547100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 274346-197 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 2780071 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.