Provider Demographics
NPI:1063727618
Name:SUMMER, DAN (LCAT)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:SUMMER
Suffix:
Gender:M
Credentials:LCAT
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:SUMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT
Mailing Address - Street 1:6510 99TH ST STE LL1
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3536
Mailing Address - Country:US
Mailing Address - Phone:718-541-2509
Mailing Address - Fax:
Practice Address - Street 1:6510 99TH ST STE LL1
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3536
Practice Address - Country:US
Practice Address - Phone:718-541-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000587221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist