Provider Demographics
NPI:1780607085
Name:DR RICHARD J D'AMICO DO PC
Entity type:Organization
Organization Name:DR RICHARD J D'AMICO DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-324-3074
Mailing Address - Street 1:74 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-324-3074
Mailing Address - Fax:518-324-3077
Practice Address - Street 1:74 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2925
Practice Address - Country:US
Practice Address - Phone:518-324-3074
Practice Address - Fax:518-324-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373424OtherUNITED HEALTH CARE
6780727OtherCIGNA
113464783DA01OtherCARE PLUS
1P1236OtherHEALTHNET
228208OtherHIP
228208OtherVYTRA
228208-A39OtherHEALTHFIRST
1000040970OtherAFFINITY
P3074361OtherOXFORD
PPO 5996717 HMO 0000OtherGH1
NY02498846Medicaid
22820801OtherNEIGHBORHOOD
EMPIRE BCBBOther0782P1
1000040970OtherAFFINITY
228208-A39OtherHEALTHFIRST
=========OtherMULTIPLAN
PPO 5996717 HMO 0000OtherGH1
228208OtherVYTRA
2373424OtherUNITED HEALTH CARE