Provider Demographics
NPI:1386771806
Name:DEGEN, DANIEL ANTHONY (OTR)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANTHONY
Last Name:DEGEN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 ROCKWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-1612
Mailing Address - Country:US
Mailing Address - Phone:585-720-9608
Mailing Address - Fax:
Practice Address - Street 1:262 ROCKWAY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-1612
Practice Address - Country:US
Practice Address - Phone:585-720-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008269208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106169FROtherPREFERRED CARE
NYCC7902Medicare ID - Type Unspecified