MEDICARE: DR. DOMINIQUE AIMEE JEAN 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	207LP3000X	Pediatric Anesthesiology Physician	A108347	CA
2	207L00000X	Anesthesiology Physician	300139	NY
3	207LP3000X	Pediatric Anesthesiology Physician	32732	OK
4	207LP3000X	Pediatric Anesthesiology Physician	300139	NY

General Provider Information

NPI Number	:	1326272055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIQUE AIMEE JEAN M.D.

Provider Business Mailing Address
First Line	:	2214 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-1123
Country	:	US
Telephone Number	:	516-972-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S RM BS40
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1119
Country	:	US
Telephone Number	:	718-918-5131
Fax Number	:

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

Provider Enumeration Date	:	05/09/2009
Last Update Date	:	12/05/2025

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