Individual
EILEEN FORTUNE DAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80TH ST & 41ST AVE, ELMHURST, NY 11373-1329
(718) 334-3969
(718) 334-5958
Mailing address
7901 BROADWAY, MANAGED CARE, D1-01, ELMHURST, NY 11373-1329
(718) 334-1921
(718) 334-3432
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F303572
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02695485
—
NY
Enumeration date
10/10/2006
Last updated
08/21/2015
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