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NPI Code Detail

MEDICARE: MARY M DIDOMENICO RN., MA., MED.

MEDICARE: MARY M DIDOMENICO RN., MA., MED.
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
1163W00000XRegistered Nurse613352-1NY

General Provider Information

NPI Number : 1407081318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY M DIDOMENICO RN., MA., MED.
Provider Business Mailing Address
First Line : 29 RIDGELAND ROAD
Second Line : COLONIAL HEIGHTS
City : YONKERS
State : NY
Zip : 10710-2607
Country : US
Telephone Number : 914-346-8700
Fax Number :
Provider Business Practice Location Address
First Line : 29 RIDGELAND ROAD
Second Line :
City : YONKERS
State : NY
Zip : 10710-2607
Country : US
Telephone Number : 914-346-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2009
Last Update Date : 05/20/2009

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