Healthcare Provider Details

I. General information

NPI: 1518344373
Provider Name (Legal Business Name): DOMINIQUE MARIO OMAR HIGGINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 99
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST # 99
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-3539
  • Fax:
Mailing address:
  • Phone: 646-962-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2022-02706
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME150032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: