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General NPI Number Information
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NPI Number | 1265970834
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Entity Type | Organization
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Legal Business Name | DAMIAN FAMILY CARE CENTERS, INC.
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 161 LAKE SHORE RD
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-3182
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Country | US
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Telephone | 631-306-5895
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Fax | 718-657-1870
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Provider Business Mailing Address
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Address Line | 8956 162ND ST FL 3
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City | JAMAICA
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State | NY
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Zip | 11432-5072
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Country | US
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Telephone | 718-657-1100
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Fax | 718-657-1870
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | MR. PETER GRISAFI
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Credential |
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Telephone | 718-657-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 7003246R
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License Number State | NY
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