Healthcare Provider Details

I. General information

NPI: 1174299960
Provider Name (Legal Business Name): GRACE DAMASCO MS, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 54TH ST, 2N
NEW YORK NY
10022-4639
US

IV. Provider business mailing address

678 HEWLETT ST
FRANKLIN SQUARE NY
11010-1832
US

V. Phone/Fax

Practice location:
  • Phone: 212-570-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: