Provider Demographics
NPI:1053406769
Name:COLETTI, DANIEL J (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:COLETTI
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:865 NORTHERN BLVD, SUITE 102
Mailing Address - Street 2:NORTHWELL DIVISION OF GENERAL INTERNAL MEDICINE
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-622-5035
Mailing Address - Fax:516-622-5005
Practice Address - Street 1:865 NORTHERN BLVD, SUITE 102
Practice Address - Street 2:NORTHWELL DIVISION OF GENERAL INTERNAL MEDICINE
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-622-5035
Practice Address - Fax:516-622-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical