Healthcare Provider Details

I. General information

NPI: 1992193874
Provider Name (Legal Business Name): DAMIAN FAMILY CARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137-50 JAMAICA AVENUE
JAMAICA NY
11435
US

IV. Provider business mailing address

138-02 QUEENS BOULEVARD
BRIARWOOD NY
11435
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-5100
  • Fax: 718-298-5128
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 Number7003246R
License Number StateNY

VIII. Authorized Official

Name: JOHN CHUE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 718-657-1100