MEDICARE: DR. ELENA DAMIANO DDS

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	1223G0001X	General Practice Dentistry	044697	NY

General Provider Information

NPI Number	:	1801007935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELENA DAMIANO DDS

Provider Business Mailing Address
First Line	:	345 E 24TH ST
Second Line	:	4S
City	:	NEW YORK
State	:	NY
Zip	:	10010-4020
Country	:	US
Telephone Number	:	212-998-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	11439 SUTPHIN BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-1022
Country	:	US
Telephone Number	:	718-945-7150
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/11/2014

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