Provider Demographics
NPI:1760574479
Name:DAURA, DAMON (PT)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:DAURA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ANDREWS DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2672
Mailing Address - Country:US
Mailing Address - Phone:973-237-1975
Mailing Address - Fax:973-237-1977
Practice Address - Street 1:2 ANDREWS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2672
Practice Address - Country:US
Practice Address - Phone:973-237-1975
Practice Address - Fax:973-237-1977
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00548200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072457R02Medicare PIN
NJP96412Medicare UPIN