Healthcare Provider Details

I. General information

NPI: 1801007935
Provider Name (Legal Business Name): ELENA DAMIANO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11439 SUTPHIN BLVD
JAMAICA NY
11434-1022
US

IV. Provider business mailing address

345 E 24TH ST 4S
NEW YORK NY
10010-4020
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax:
Mailing address:
  • Phone: 212-998-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: