Provider Demographics
NPI:1912157116
Name:D'AMATO, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:D'AMATO
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 1:355 BARD AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1664
Mailing Address - Country:US
Mailing Address - Phone:201-600-5119
Mailing Address - Fax:718-818-5813
Practice Address - Street 1:355 BARD AVENUE APT 6E
Practice Address - Street 2:RICHMOND UNIVERSITY MEDICAL CTR
Practice Address - City:STATEN ISLAN
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:201-600-5119
Practice Address - Fax:718-818-5813
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2503922084P0800X
NJMA848732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry