Provider Demographics
NPI:1811973852
Name:FERRARA, DANIEL R (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:FERRARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826223
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6223
Mailing Address - Country:US
Mailing Address - Phone:866-898-7142
Mailing Address - Fax:770-237-1723
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170935-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01175713Medicaid
NY03E352OtherBLUECROSS BLUESHIELD
NY1648Q1OtherBCBS
930111753OtherRAILROAD
NY03E351Medicare PIN
NY01175713Medicaid
930113071Medicare PIN
NY03E352Medicare PIN
500023658Medicare PIN