Provider Demographics
NPI:1427098573
Name:GOLLIN, DANIEL B (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:GOLLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:351 BELGROVE DR
Mailing Address - Street 2:APT. 2
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1626
Mailing Address - Country:US
Mailing Address - Phone:201-991-0880
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1228
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-3619
Practice Address - Fax:212-289-4096
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2250192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2165N1OtherPROVIDER ID#
NY02423201Medicaid
NYI01941Medicare UPIN