MEDICARE: DOMINIC PAMINTUAN MD

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	207R00000X	Internal Medicine Physician	25MA08618100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611521901	OTHER	VA	US DEPT OF LABOR
2	611521902	OTHER	VA	US DEPT OF LABOR
3	611521900	OTHER	VA	US DEPT OF LABOR

General Provider Information

NPI Number	:	1124034897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC PAMINTUAN MD

Provider Business Mailing Address
First Line	:	PO BOX 8519
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-8519
Country	:	US
Telephone Number	:	732-460-9840
Fax Number	:	732-460-9848

Provider Business Practice Location Address
First Line	:	569 RIVER RD
Second Line	:
City	:	FAIR HAVEN
State	:	NJ
Zip	:	07704-3262
Country	:	US
Telephone Number	:	732-530-0100
Fax Number	:	732-530-5895

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/02/2010

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Directions to “ DOMINIC PAMINTUAN MD” Practice Location

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