Healthcare Provider Details

I. General information

NPI: 1316222789
Provider Name (Legal Business Name): HELAINE DOMINGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 56TH ST
BROOKLYN NY
11219-4616
US

IV. Provider business mailing address

35 RIVER DR S #507
JERSEY CITY NJ
07310-3798
US

V. Phone/Fax

Practice location:
  • Phone: 718-851-7100
  • Fax: 718-437-6397
Mailing address:
  • Phone: 201-360-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199565-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: