Provider Demographics
NPI:1134113988
Name:DAMICO, EDWARD LEONARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEONARD
Last Name:DAMICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1603
Mailing Address - Country:US
Mailing Address - Phone:516-826-0103
Mailing Address - Fax:516-783-6657
Practice Address - Street 1:1685 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1603
Practice Address - Country:US
Practice Address - Phone:516-826-0103
Practice Address - Fax:516-783-6657
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003837213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00907960Medicaid
T51219Medicare UPIN
NYP39921Medicare ID - Type Unspecified