MEDICARE: DR. NORMAN EUSTAQUIO SANTO DOMINGO 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
1	208000000X	Pediatrics Physician	25MA04522900	NJ

General Provider Information

NPI Number	:	1083677553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN EUSTAQUIO SANTO DOMINGO M.D.

Provider Business Mailing Address
First Line	:	800 ROUTE 9
Second Line	:	SUITE 4
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3068
Country	:	US
Telephone Number	:	732-269-4100
Fax Number	:	732-269-2356

Provider Business Practice Location Address
First Line	:	800 ROUTE 9
Second Line	:	SUITE 4
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3068
Country	:	US
Telephone Number	:	732-269-4100
Fax Number	:	732-269-2356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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