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General NPI Number Information
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NPI Number | 1942457965
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Entity Type | Individual
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Provider Name | MICHAL DOMENY L.AC, CD/N
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Gender | Male
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 678 E 24TH ST
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City | BROOKLYN
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State | NY
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Zip | 11210-1132
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Country | US
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Telephone | 347-693-7659
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 402 BOX 1314
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City | APO
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State | AE
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Zip | 09180-0014
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Country | US
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Telephone |
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Fax |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 006241-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003443-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 337835
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 645452-1
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License Number State | NY
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