Provider Demographics
NPI:1891051322
Name:DE JESUS, DAMARIS
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHARLES LINDBERGH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3653
Mailing Address - Country:US
Mailing Address - Phone:516-227-8703
Mailing Address - Fax:
Practice Address - Street 1:9004 161ST ST
Practice Address - Street 2:SUITE 304
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6141
Practice Address - Country:US
Practice Address - Phone:718-206-1000
Practice Address - Fax:718-206-1077
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator