Provider Demographics
NPI:1588099600
Name:MENNA, DANIELLE MARISSA (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARISSA
Last Name:MENNA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARISSA
Other - Last Name:RODIN-GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:108 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2209
Mailing Address - Country:US
Mailing Address - Phone:646-533-0333
Mailing Address - Fax:
Practice Address - Street 1:317 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5313
Practice Address - Country:US
Practice Address - Phone:516-292-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist