RANDY SCOTT D'AMICO, M.D. - NPI NUMBER 1376809582

Summary

Provider Name: RANDY SCOTT D'AMICO, M.D.

NPI Number: 1376809582

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Address:
710 W 168TH ST
DEPARTMENT OF NEUROLOGICAL SURGERY
NEW YORK, NY
ZIP 10032

Phone Number: (212) 305-4118



Detailed Information

Randy Scott D'amico, M.D. is a student in an organized health care education/training program in New York, NY. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1376809582 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

710 W 168TH ST
DEPARTMENT OF NEUROLOGICAL SURGERY
NEW YORK, NY
ZIP 10032-726
Phone: (212) 305-4118

The enumeration date for this NPI number is 4/2/2012 and was last updated on 4/2/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program Yes

NPI Record

No. Field Name Field Value
1 NPI 1376809582
2 Entity Type Code 1
3 Provider Last Name Legal Name D'AMICO
4 Provider First Name RANDY
5 Provider Middle Name SCOTT
6 Provider Credential Text M.D.
7 Provider First Line Business Practice Location Address 710 W 168TH ST
8 Provider Second Line Business Practice Location Address DEPARTMENT OF NEUROLOGICAL SURGERY
9 Provider Business Practice Location Address City Name NEW YORK
10 Provider Business Practice Location Address State Name NY
11 Provider Business Practice Location Address Postal Code 100323726
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 2123054118
14 Provider Enumeration Date 4/2/2012
15 Last Update Date 4/2/2012
16 Provider Gender Code M
17 Healthcare Provider Taxonomy Code 1 390200000X
18 Healthcare Provider Primary Taxonomy Switch 1 Y
19 Is Sole Proprietor Y

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This page was last updated on: 8/12/2014
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