MEDICARE: PETER J D'AMICO PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	014002	NY

General Provider Information

NPI Number	:	1376607598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J D'AMICO PHD

Provider Business Mailing Address
First Line	:	400 LAKEVILLE ROAD
Second Line	:	SUITE 244
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042
Country	:	US
Telephone Number	:	718-470-8352
Fax Number	:	516-358-2629

Provider Business Practice Location Address
First Line	:	400 LAKEVILLE RD
Second Line	:	SUITE 244
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1121
Country	:	US
Telephone Number	:	718-470-8352
Fax Number	:	516-358-2629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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