Basic Information
| Provider Information | |||||||||
| NPI: | 1154300739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICOSTANZO | ||||||||
| FirstName: | DAMIAN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149328029 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | PORT CHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105734943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009423376 | ||||||||
| FaxNumber: | 9149349819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 06/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 168313 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0101X | 168313 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.