Provider Demographics
NPI:1396351748
Name:MOLDWIN, DANIEL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MOLDWIN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:MOLDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:176 N VILLAGE AVE STE 2G
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3800
Mailing Address - Country:US
Mailing Address - Phone:516-266-9110
Mailing Address - Fax:516-200-2173
Practice Address - Street 1:176 N VILLAGE AVE STE 2G
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-266-9110
Practice Address - Fax:516-200-2173
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403573363LP0808X
NY695968163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health