Healthcare Provider Details

I. General information

NPI: 1669338661
Provider Name (Legal Business Name): NATALIA DOMINGUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 GRAND ST
JERSEY CITY NJ
07302-4321
US

IV. Provider business mailing address

144 MAPLEWOOD AVE
WAYNE NJ
07470-5134
US

V. Phone/Fax

Practice location:
  • Phone: 201-915-2000
  • Fax:
Mailing address:
  • Phone: 201-957-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: