Provider Demographics
NPI:1699066738
Name:ANDERSON, DANIEL PARKER (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PARKER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2005
Mailing Address - Country:US
Mailing Address - Phone:203-688-2259
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:32 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2005
Practice Address - Country:US
Practice Address - Phone:203-688-2259
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09449400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty