Provider Demographics
NPI:1518074822
Name:DAMIANO, ANGELA (MS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DAMIANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9018
Practice Address - Street 1:1055 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1045
Practice Address - Country:US
Practice Address - Phone:914-693-7636
Practice Address - Fax:914-886-0027
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198838207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01821181Medicaid
NY01821181Medicaid
NY03Z432Medicare ID - Type Unspecified