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General NPI Number Information
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NPI Number | 1619221926
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Entity Type | Organization
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Legal Business Name | RYAN D'AMICO DPM PLLC
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 7075 MANLIUS CENTER RD
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-2607
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Country | US
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Telephone | 315-446-3668
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Fax | 315-849-1182
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Provider Business Mailing Address
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Address Line | 7075 MANLIUS CENTER RD
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-2607
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Country | US
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Telephone | 315-446-3668
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Fax | 315-849-1182
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Authorized Official
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Title or Position | OWNER
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Name | RYAN L. D'AMICO
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Credential | DPM
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Telephone | 315-446-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 006349
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License Number State | NY
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