Provider Demographics
NPI:1356457923
Name:DAMATO, ANTHONY PETER (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PETER
Last Name:DAMATO
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 1:35 BEACHMONT TER
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4617
Mailing Address - Country:US
Mailing Address - Phone:973-228-3676
Mailing Address - Fax:
Practice Address - Street 1:199 BROAD ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2635
Practice Address - Country:US
Practice Address - Phone:973-748-3300
Practice Address - Fax:973-748-3802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02859500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2203308Medicaid
NJ0026356OtherAETNA
NJ1012252OtherHORIZON NJ HEALTH
NJP2362050OtherOXFORD
NJ2203308Medicaid
NJC55836Medicare UPIN