Provider Demographics
NPI:1124204466
Name:PASSANESE, DANIEL (LMT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:PASSANESE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10158 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2793
Mailing Address - Country:US
Mailing Address - Phone:716-297-3300
Mailing Address - Fax:716-297-3300
Practice Address - Street 1:10158 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2793
Practice Address - Country:US
Practice Address - Phone:716-297-3300
Practice Address - Fax:716-297-3300
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist