MEDICARE: RYAN D'AMICO DPM PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	006349	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619221926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN D'AMICO DPM PLLC

Provider Business Mailing Address
First Line	:	7075 MANLIUS CENTER RD
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-2607
Country	:	US
Telephone Number	:	315-446-3668
Fax Number	:	315-849-1182

Provider Business Practice Location Address
First Line	:	7075 MANLIUS CENTER RD
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-2607
Country	:	US
Telephone Number	:	315-446-3668
Fax Number	:	315-849-1182

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN L. D'AMICO
Credential	:	DPM
Telephone Number	:	315-446-3668

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	05/01/2019

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