Basic Information
| Provider Information | |||||||||
| NPI: | 1548208473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMOU | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 937 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313690777 | ||||||||
| FaxNumber: | 6313690976 | ||||||||
| Practice Location | |||||||||
| Address1: | 937 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313690777 | ||||||||
| FaxNumber: | 6313690976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 001514 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 2148612 | 05 | NY | MEDICAID |