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NPI Code Detail

MEDICARE: DR. MARY JOELANNY DOMINGUEZ M.D.

MEDICARE: DR. MARY JOELANNY DOMINGUEZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician288124NY

General Provider Information

NPI Number : 1043568835
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY JOELANNY DOMINGUEZ M.D.
Provider Business Mailing Address
First Line : 3411 WAYNE AVE # 5H
Second Line :
City : BRONX
State : NY
Zip : 10467-2509
Country : US
Telephone Number : 718-920-5442
Fax Number :
Provider Business Practice Location Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 718-920-5442
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2012
Last Update Date : 03/18/2026

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