MEDICARE: DOT CERTIFIED, LLC

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	363LP2300X	Primary Care Nurse Practitioner	334735	NY

General Provider Information

NPI Number	:	1356742654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOT CERTIFIED, LLC

Provider Business Mailing Address
First Line	:	PO BOX 16960
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-0960
Country	:	US
Telephone Number	:	585-957-5070
Fax Number	:	585-368-9986

Provider Business Practice Location Address
First Line	:	128 COUNTRY WOOD LNDG
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4408
Country	:	US
Telephone Number	:	585-957-5070
Fax Number	:	585-368-9986

Authorized Official
Title or Position	:	FOUNDER AND PRESIDENT
Name	:	DR. JOSEPH NVAYO NDONGWA
Credential	:	DNP, FNP-C
Telephone Number	:	585-957-5070

Provider Enumeration Date	:	09/06/2014
Last Update Date	:	09/06/2014

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