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General NPI Number Information
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NPI Number | 1982966560
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Entity Type | Organization
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Legal Business Name | RICHARD A. D'AMICO, MD PA
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 180 N DEAN ST SUITE 3N
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2534
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Country | US
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Telephone | 201-567-9595
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Fax | 201-567-1813
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Provider Business Mailing Address
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Address Line | 180 N DEAN ST SUITE 3N
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2534
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Country | US
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Telephone | 201-567-9595
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Fax | 201-567-1813
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD A D'AMICO
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Credential | MD
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Telephone | 201-567-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 25MA041772
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License Number State | NJ
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