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NPI Code Detail

MEDICARE: DR. ANNA THERESE DOMINGO DO

MEDICARE: DR. ANNA THERESE DOMINGO DO
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
1207V00000XObstetrics & Gynecology Physician309964NY
2390200000XStudent in an Organized Health Care Education/Training Program
3207V00000XObstetrics & Gynecology Physician25MB11579200NJ

General Provider Information

NPI Number : 1316479728
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNA THERESE DOMINGO DO
Provider Business Mailing Address
First Line : 470 N FRANKLIN TPKE STE 202
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1385
Country : US
Telephone Number : 201-236-2100
Fax Number :
Provider Business Practice Location Address
First Line : 470 N FRANKLIN TPKE STE 202
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1385
Country : US
Telephone Number : 201-236-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2017
Last Update Date : 03/27/2023

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Directions to “ DR. ANNA THERESE DOMINGO DO” Practice Location

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