Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Damien Anthony Decollibus, PA

Individual provider Surgical Physician Assistant · NPI 1114009115

Mr. Damien Anthony Decollibus, PA is a Physician Assistant in New York, New York. Graduated from State University of New York at Stony Brook, School of Medicine in 2004, 22 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
22
Trained at
State University of New York at Stony Brook, School of Medicine
Licensed in
NY
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

100 E 77th St Division Of Vascular Surgery
New York, NY 10075-1850
Phone: (212) 434-4264
Fax: (212) 434-4231
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 010067 (NY)

Record details

NPI number1114009115
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 19, 2006
Last updated in NPPESSeptember 10, 2008

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSTATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduated 2004 (22 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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