Healthcare Provider Details

I. General information

NPI: 1972670271
Provider Name (Legal Business Name): DOMINICK ANTHONY DAGOSTINO JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 MANNER AVE
GARFIELD NJ
07026-1418
US

IV. Provider business mailing address

96 MANNER AVE
GARFIELD NJ
07026-1418
US

V. Phone/Fax

Practice location:
  • Phone: 973-772-0099
  • Fax: 973-772-0099
Mailing address:
  • Phone: 973-772-0099
  • Fax: 973-772-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00541800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX009210-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: