Provider Demographics
NPI:1013581370
Name:D'AMATO, MICHAEL (CNIM, R EEG T)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:D'AMATO
Suffix:
Gender:M
Credentials:CNIM, R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 51ST AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5821
Mailing Address - Country:US
Mailing Address - Phone:347-622-2458
Mailing Address - Fax:
Practice Address - Street 1:140 ADAMS AVE STE B13
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3618
Practice Address - Country:US
Practice Address - Phone:631-617-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47202084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology