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General NPI Number Information
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NPI Number | 1598503872
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Entity Type | Individual
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Provider Name | DOMINIQUE GOODWIN PA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2024
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 3007 36TH AVE STE A
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City | ASTORIA
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State | NY
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Zip | 11106-2314
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Country | US
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Telephone | 917-310-3371
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Fax | 516-938-1554
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Provider Business Mailing Address
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Address Line | 135 MINEOLA BLVD FL 2
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City | MINEOLA
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State | NY
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Zip | 11501-3917
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Country | US
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Telephone | 917-310-3371
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Fax | 516-938-1554
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 032438
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License Number State | NY
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