Provider Demographics
NPI:1598861585
Name:DR. THEODORE D'AMATO, PC
Entity Type:Organization
Organization Name:DR. THEODORE D'AMATO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-836-1374
Mailing Address - Street 1:214 CHAMBERSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-2802
Mailing Address - Country:US
Mailing Address - Phone:732-836-1374
Mailing Address - Fax:732-836-1384
Practice Address - Street 1:214 CHAMBERSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-2802
Practice Address - Country:US
Practice Address - Phone:732-836-1374
Practice Address - Fax:732-836-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6529280001Medicare NSC
NJ116760Medicare PIN
NYPBWB51Medicare PIN