1124114491 NPI number — DR. YVON DAMOUR M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124114491 NPI number — DR. YVON DAMOUR M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DAMOUR

Provider First Name:

YVON

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1124114491

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 272

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EAST ISLIP

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11730-0272

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

631-224-1878

Provider Business Mailing Address Fax Number:

631-224-7963

Provider First Line Business Practice Location Address:

200 BELLE TERRE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PORT JEFFERSON

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11777-1928

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

631-474-6000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  189488-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 189488 . This is a "HIP HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2121564 . This is a "VYTRA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4C9011 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5821360 . This is a "AETNA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: ON25343 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P3555368 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: YD0638Y82 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01654948 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 2695524 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1000054073 . This is a "AFFINITY HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 9062538 . This is a "CIGNA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".