Individual
MR. DAMIEN T FAILLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
707 E MAIN ST, MIDDLETOWN, NY 10940-2650
(845) 333-7575
(845) 333-1454
Mailing address
707 E MAIN ST, MIDDLETOWN, NY 10940-2650
(845) 333-7575
(845) 333-1454
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
014579
NY
363AS0400X
Surgical Physician Assistant
Primary
014579
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03656622
—
NY
Enumeration date
01/28/2011
Last updated
04/16/2018
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