MEDICARE: DAMIAN FAMILY CARE CENTERS, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)	7003246R	NY

General Provider Information

NPI Number	:	1477909349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMIAN FAMILY CARE CENTERS, INC.

Provider Business Mailing Address
First Line	:	8956 162ND ST FL 3
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-5072
Country	:	US
Telephone Number	:	718-657-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233
Country	:	US
Telephone Number	:	718-581-5798
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. KAVANAUGH CHANDLER
Credential	:	MD
Telephone Number	:	718-657-1100

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	06/11/2026

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