Provider Demographics
NPI:1659426468
Name:D'AMICO, THOMAS JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BITTERSWEET CT
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1765
Mailing Address - Country:US
Mailing Address - Phone:631-681-4550
Mailing Address - Fax:
Practice Address - Street 1:7 BITTERSWEET CT
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1765
Practice Address - Country:US
Practice Address - Phone:631-681-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOP-CFP-223938-2OtherWORKERS COMPENSATION
NY2583273Medicaid
NYI01729Medicare UPIN
NY0221P2Medicare ID - Type Unspecified