Healthcare Provider Details

I. General information

NPI: 1366015828
Provider Name (Legal Business Name): DAMIAN FAMILY CARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8956 162ND ST
JAMAICA NY
11432-5072
US

IV. Provider business mailing address

8956 162ND ST
JAMAICA NY
11432-5072
US

V. Phone/Fax

Practice location:
  • Phone: 347-505-7000
  • Fax: 347-505-2500
Mailing address:
  • Phone: 718-657-1100
  • Fax: 718-657-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PETER A GRISAFI
Title or Position: CEO
Credential:
Phone: 718-657-1100