Healthcare Provider Details

I. General information

NPI: 1366700874
Provider Name (Legal Business Name): DOMINIQUE DRUMMOND BAILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W. 168TH STREET - CHN 517 COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK NY
10032
US

IV. Provider business mailing address

622 W 168TH ST PH 17-105I
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 610-564-4541
  • Fax:
Mailing address:
  • Phone: 212-305-5903
  • Fax: 212-342-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number273430
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: