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	:	1972982528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMIAN FAMILY CARE CENTERS, INC.

Provider Business Mailing Address
First Line	:	89-56 162ND STREET
Second Line	:	3RD FLOOR
City	:	JAMAICA
State	:	NY
Zip	:	11432-5072
Country	:	US
Telephone Number	:	718-657-1100
Fax Number	:	718-657-1870

Provider Business Practice Location Address
First Line	:	130-20 89TH ROAD
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418
Country	:	US
Telephone Number	:	929-335-6541
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. PETER GRISAFI
Credential	:
Telephone Number	:	718-657-1100

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	03/10/2026

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