Provider Demographics
NPI:1376607598
Name:D'AMICO, PETER J (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKEVILLE ROAD
Mailing Address - Street 2:SUITE 244
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:718-470-8352
Mailing Address - Fax:516-358-2629
Practice Address - Street 1:400 LAKEVILLE RD
Practice Address - Street 2:SUITE 244
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-8352
Practice Address - Fax:516-358-2629
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0140022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry