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General NPI Number Information
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NPI Number | 1912465980
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Entity Type | Organization
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Legal Business Name | ELVITA GENELUS-DOMINIQUE, D.O, F.A.C.S, P.C
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 5850 CATALPA AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5028
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Country | US
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Telephone | 718-821-1910
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Fax | 718-821-1125
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Provider Business Mailing Address
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Address Line | 628 LENORE LN
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City | ELMONT
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State | NY
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Zip | 11003-4526
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Country | US
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Telephone | 516-721-5168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELVITA GENELUS-DOMINIQUE
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Credential | DO
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Telephone | 516-721-5168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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