Provider Demographics
NPI:1093071714
Name:D'AMICO, MALARIE (MALARIE D'AMICO)
Entity Type:Individual
Prefix:MRS
First Name:MALARIE
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:MALARIE D'AMICO
Other - Prefix:MRS
Other - First Name:MALARIE
Other - Middle Name:
Other - Last Name:D'AMICO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MALARIE D'AMICO
Mailing Address - Street 1:734 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:734 S 8TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5526
Practice Address - Country:US
Practice Address - Phone:631-375-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
NY017011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist