Provider Demographics
NPI:1992102644
Name:DECESARE, DANIELLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:
Last Name:DECESARE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-326-4160
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:ADVANCED DERMATOLOGY, PC
Practice Address - Street 2:2627 B HYLAN BLVD (LOWER LEVEL)
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306
Practice Address - Country:US
Practice Address - Phone:718-351-8101
Practice Address - Fax:718-667-0250
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant