Provider Demographics
NPI:1396012795
Name:DAMIANI, JOSEPH LIDIO (DPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LIDIO
Last Name:DAMIANI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15B BROOKSIDE HTS
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1638
Mailing Address - Country:US
Mailing Address - Phone:845-641-4637
Mailing Address - Fax:
Practice Address - Street 1:15B BROOKSIDE HTS
Practice Address - Street 2:
Practice Address - City:WANAQUE
Practice Address - State:NJ
Practice Address - Zip Code:07465-1638
Practice Address - Country:US
Practice Address - Phone:845-641-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01480400225100000X
CA37032225100000X
NY032987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist