Provider Demographics
NPI:1003294307
Name:DAMIAN FAMILY CARE CENTERS, INC.
Entity Type:Organization
Organization Name:DAMIAN FAMILY CARE CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-657-1100
Mailing Address - Street 1:8956 162ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5072
Mailing Address - Country:US
Mailing Address - Phone:718-657-1100
Mailing Address - Fax:718-657-1870
Practice Address - Street 1:13802 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2642
Practice Address - Country:US
Practice Address - Phone:718-657-1100
Practice Address - Fax:718-657-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003246R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)