MEDICARE: DR. JOSEPH E DOMANSKI 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	207R00000X	Internal Medicine Physician	MA03285500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P878007	OTHER	NJ	OXFORD
2	11671	OTHER	NJ	GHI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1K1005	OTHER	NJ	HEALTHNET

General Provider Information

NPI Number	:	1326011909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH E DOMANSKI M.D.

Provider Business Mailing Address
First Line	:	2 BONNIE LN
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-4378
Country	:	US
Telephone Number	:	732-458-4996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 ROUTE 88
Second Line	:	SUITE 1
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-2871
Country	:	US
Telephone Number	:	732-295-2337
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOSEPH E DOMANSKI M.D.” Practice Location

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