Healthcare Provider Details

I. General information

NPI: 1104915123
Provider Name (Legal Business Name): DAMIAN FAMILY CARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 53RD ST
NEW YORK NY
10022
US

IV. Provider business mailing address

8956 162ND ST FL 3
JAMAICA NY
11432-5072
US

V. Phone/Fax

Practice location:
  • Phone: 212-904-1721
  • Fax: 212-904-1444
Mailing address:
  • Phone: 718-657-1100
  • Fax: 718-657-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number7003246R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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