MR. DAMIEN ANTHONY DECOLLIBUS PA NPI 1114009115

NPI Information

NPI: 1114009115
Provider Name: MR. DAMIEN ANTHONY DECOLLIBUS, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
100 E 77TH ST
DIVISION OF VASCULAR SURGERY
NEW YORK, NY
ZIP 10075
Phone: (212) 434-4264
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MR. Damien Anthony Decollibus, PA is a surgical physician assistant in New York, NY with 20 years of experience. MR. Damien Anthony Decollibus, PA NPI is 1114009115. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: STATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduation Year:2004

The provider's business location address is:

100 E 77TH ST
DIVISION OF VASCULAR SURGERY
NEW YORK, NY
ZIP 10075-850
Phone: (212) 434-4264
Fax: (212) 434-4231

The NPI 1114009115 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/19/2006 and was last updated on 9/10/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	363AS0400X	Physician Assistant	Surgical	010067	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00246075	MEDICAID	NEW YORK
2	00330231	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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