Individual
MR. DAMIEN ANTHONY DECOLLIBUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 E 77TH ST, DIVISION OF VASCULAR SURGERY, NEW YORK, NY 10075-1850
(212) 434-4264
(212) 434-4231
Mailing address
100 E 77TH ST, DIVISION OF VASCULAR SURGERY, NEW YORK, NY 10075-1850
(212) 434-4264
(212) 434-4231
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
010067
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00246075
—
NY
Enumeration date
10/19/2006
Last updated
09/10/2008
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