Healthcare Provider Details

I. General information

NPI: 1821915133
Provider Name (Legal Business Name): DAMIAN ILLARDO CRPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 8TH ST
STATEN ISLAND NY
10306-2929
US

IV. Provider business mailing address

23 8TH ST
STATEN ISLAND NY
10306-2929
US

V. Phone/Fax

Practice location:
  • Phone: 329-239-1556
  • Fax:
Mailing address:
  • Phone: 329-239-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: