Healthcare Provider Details

I. General information

NPI: 1922289933
Provider Name (Legal Business Name): PHILIP JOSEPH DADDONA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 AMBOY RD
STATEN ISLAND NY
10312-3820
US

IV. Provider business mailing address

118 BATTERY AVE APT 2 D
BROOKLYN NY
11209-6404
US

V. Phone/Fax

Practice location:
  • Phone: 718-227-3049
  • Fax: 718-227-3056
Mailing address:
  • Phone: 718-833-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31579
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: