Basic Information
Provider Information
NPI: 1578099891
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAZMIERSKI
FirstName: DANIEL
MiddleName: CAESAR
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1205 LONGVIEW TER
Address2:  
City: WAVERLY TOWNSHIP
State: PA
PostalCode: 184118990
CountryCode: US
TelephoneNumber: 5708627171
FaxNumber:  
Practice Location
Address1: 259 1ST ST
Address2:  
City: MINEOLA
State: NY
PostalCode: 115013957
CountryCode: US
TelephoneNumber: 5166638963
FaxNumber: 5166638964
Other Information
ProviderEnumerationDate: 05/05/2017
LastUpdateDate: 08/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X308797NYY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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