Basic Information
Provider Information
NPI: 1972529683
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DANISI
FirstName: JOEL
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1611 NW12TH AVENUE
Address2: PO BOX 016960 (M851)
City: MIAMI
State: FL
PostalCode: 33136
CountryCode: US
TelephoneNumber: 3052437688
FaxNumber: 3052438470
Practice Location
Address1: 1475 NW 12TH AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331361002
CountryCode: US
TelephoneNumber: 3052437688
FaxNumber: 3052438470
Other Information
ProviderEnumerationDate: 07/14/2006
LastUpdateDate: 01/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0300XME109398FLY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

No ID Information.


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