Provider Demographics
NPI:1922289933
Name:DADDONA, PHILIP JOSEPH (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:DADDONA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BATTERY AVE
Mailing Address - Street 2:APT 2 D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6404
Mailing Address - Country:US
Mailing Address - Phone:718-833-1560
Mailing Address - Fax:
Practice Address - Street 1:4368 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3820
Practice Address - Country:US
Practice Address - Phone:718-227-3049
Practice Address - Fax:718-227-3056
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18Medicaid