=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922281872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL L. DOMBROSKI, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2007
-----------------------------------------------------
Last Update Date | 12/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PHYSICIANS OFFICE BLDG. N. STE. 4U COMMUNITY GENERAL HOSPITAL
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-492-5777
-----------------------------------------------------
Fax | 315-492-5892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PHYSICIANS OFFICE BLDG. N. STE. 4U COMMUNITY GENERAL HOSPITAL
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-492-5777
-----------------------------------------------------
Fax | 315-492-5892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MARIANNE DILLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-488-5588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 086934-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------