Healthcare Provider Details

I. General information

NPI: 1700960333
Provider Name (Legal Business Name): DOMINIQUE DELMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOXHALL AVE
KINGSTON NY
12401-5107
US

IV. Provider business mailing address

1 FOXHALL AVE
KINGSTON NY
12401-5107
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-8444
  • Fax: 845-338-2906
Mailing address:
  • Phone: 845-338-8444
  • Fax: 845-338-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0025522
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA11699300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number206186-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: