Provider Demographics
NPI:1982966560
Name:RICHARD A. D'AMICO, MD PA
Entity Type:Organization
Organization Name:RICHARD A. D'AMICO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-9595
Mailing Address - Street 1:180 N DEAN ST
Mailing Address - Street 2:SUITE 3N
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2534
Mailing Address - Country:US
Mailing Address - Phone:201-567-9595
Mailing Address - Fax:201-567-1813
Practice Address - Street 1:180 N DEAN ST
Practice Address - Street 2:SUITE 3N
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2534
Practice Address - Country:US
Practice Address - Phone:201-567-9595
Practice Address - Fax:201-567-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA041772208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty