MEDICARE: DOMINION SEVEN, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1467918185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION SEVEN, LLC

Provider Business Mailing Address
First Line	:	392 E TREMONT AVE STE 45
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-4241
Country	:	US
Telephone Number	:	646-732-5592
Fax Number	:

Provider Business Practice Location Address
First Line	:	392 E TREMONT AVE STE 45
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-4241
Country	:	US
Telephone Number	:	646-732-5592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GERMAIN TANDOH
Credential	:
Telephone Number	:	646-732-5592

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/19/2019

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Directions to “DOMINION SEVEN, LLC ” Practice Location

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