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General NPI Number Information
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NPI Number | 1790852671
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Entity Type | Individual
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Provider Name | MARYANN D'AMARA DPM
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 325 MIDDLE COUNTRY RD SUITE 4
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City | SELDEN
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State | NY
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Zip | 11784-2545
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Country | US
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Telephone | 631-320-1990
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Fax | 631-320-1988
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Provider Business Mailing Address
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Address Line | 1001 MILDRED DRIVE
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City | BALDWIN
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State | NY
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Zip | 11510-5045
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Country | US
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Telephone | 516-868-7699
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Fax |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N003628
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License Number State | NY
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