Provider Demographics
NPI:1184720161
Name:D'AMATO, THEODORE A (DPM)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:A
Last Name:D'AMATO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:732-936-1384
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:732-936-1384
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00271000213ES0103X
NYN005580213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8925607Medicaid
U87925Medicare UPIN
NJ8925607Medicaid
NJ061459Medicare PIN
NYPG6141Medicare PIN