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General NPI Number Information
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NPI Number | 1710016795
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Entity Type | Individual
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Provider Name | DIANE D'AMICO P.A.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1408 RICHMOND RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2312
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Country | US
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Telephone | 718-226-2642
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Fax | 718-226-2652
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Provider Business Mailing Address
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Address Line | 236 KING ST
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6206
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Country | US
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Telephone | 718-948-3487
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Fax | 718-226-2652
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002341
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License Number State | NY
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