Provider Demographics
NPI:1831961606
Name:WHITELY, DANIEL ELLIOTT (DIPL)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ELLIOTT
Last Name:WHITELY
Suffix:
Gender:M
Credentials:DIPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GLEN HEAD RD STE 155
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1945
Mailing Address - Country:US
Mailing Address - Phone:516-200-5249
Mailing Address - Fax:
Practice Address - Street 1:333 GLEN HEAD RD STE 155
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1945
Practice Address - Country:US
Practice Address - Phone:516-200-5249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007378-01171100000X
NY007378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist