Provider Demographics
NPI: | 1932193513 |
---|---|
Name: | D'AMORE, JOSEPH F (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | JOSEPH |
Middle Name: | F |
Last Name: | D'AMORE |
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: | 68 NASSAU RD |
Mailing Address - Street 2: | |
Mailing Address - City: | HUNTINGTON |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11743-3526 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 631-423-5599 |
Mailing Address - Fax: | 631-423-9137 |
Practice Address - Street 1: | 3350 VICTORY BLVD |
Practice Address - Street 2: | |
Practice Address - City: | STATEN ISLAND |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10314-6792 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-551-1580 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-09-09 |
Last Update Date: | 2025-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 149503 | 174400000X, 207K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 95S341 | Other | BLUE CROSS |
NY | 00825003 | Medicaid | |
NY | 06170G | Medicare ID - Type Unspecified | |
NY | 95S341 | Other | BLUE CROSS |
NY | 00825003 | Medicaid |