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General NPI Number Information
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NPI Number | 1689742694
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Entity Type | Individual
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Provider Name | GRACE RITA R DOMINGO NP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 530 1ST AVE # SKI-9R LEON H CHARNEY DIVISION OF CARDIOLOGY
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 212-263-8177
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Fax | 212-263-3988
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Provider Business Mailing Address
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Address Line | 530 1ST AVE SKI-9R
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City | NEW YORK
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State | NY
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Zip | 10016-6497
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Country | US
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Telephone | 212-263-8177
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Fax | 212-263-3988
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 334785-1
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License Number State | NY
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