Provider Demographics
NPI:1124067046
Name:KREMIN, DANIEL PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PAUL
Last Name:KREMIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 LUDDINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-333-4066
Mailing Address - Fax:516-334-6222
Practice Address - Street 1:1476 LUDDINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4640
Practice Address - Country:US
Practice Address - Phone:516-333-4066
Practice Address - Fax:516-334-6222
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010582103TC0700X, 103TF0200X
VT048 0000721103TC0700X, 103TF0200X
HIPSY 862103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01513271Medicaid
NY01513271Medicaid
NYV72291Medicare UPIN