Provider Demographics
NPI:1124114491
Name:DAMOUR, YVON (MD)
Entity type:Individual
Prefix:DR
First Name:YVON
Middle Name:
Last Name:DAMOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-0272
Mailing Address - Country:US
Mailing Address - Phone:631-224-1878
Mailing Address - Fax:631-224-7963
Practice Address - Street 1:200 BELLE TERRE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1928
Practice Address - Country:US
Practice Address - Phone:631-474-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189488-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY189488OtherHIP HEALTHCARE
NY2121564OtherVYTRA HEALTH PLANS
NY4C9011OtherHEALTHNET
NY5821360OtherAETNA HEALTH PLANS
NYON25343OtherMDNY
NYP3555368OtherOXFORD HEALTH PLANS
NYYD0638Y82OtherEMPIRE BC/BS
NY01654948Medicaid
NY2695524OtherGHI
NY1000054073OtherAFFINITY HEALTH PLANS
NY9062538OtherCIGNA HEALTH PLANS