Provider Demographics
NPI:1245876325
Name:DAFFARA, DAMIAN DAVID (COO)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:DAVID
Last Name:DAFFARA
Suffix:
Gender:M
Credentials:COO
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Mailing Address - Street 1:69 NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2932
Mailing Address - Country:US
Mailing Address - Phone:917-783-4554
Mailing Address - Fax:973-325-1720
Practice Address - Street 1:355 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5118
Practice Address - Country:US
Practice Address - Phone:973-228-0072
Practice Address - Fax:973-228-2311
Is Sole Proprietor?:No
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator