Provider Demographics
NPI:1821025925
Name:DAMIEN, MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:DAMIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4179
Mailing Address - Country:US
Mailing Address - Phone:732-758-6511
Mailing Address - Fax:732-758-1048
Practice Address - Street 1:300 SHREWSBURY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4151
Practice Address - Country:US
Practice Address - Phone:732-758-6511
Practice Address - Fax:732-758-1048
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05329400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA58986Medicare UPIN