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NPI Code Detail

MEDICARE: RUTH K DOMINGUEZ ENRIQUEZ PA

MEDICARE: RUTH K DOMINGUEZ ENRIQUEZ PA
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
1363A00000XPhysician Assistant25MP00766000NJ

General Provider Information

NPI Number : 1598462228
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH K DOMINGUEZ ENRIQUEZ PA
Provider Business Mailing Address
First Line : 271 GROVE AVE STE E
Second Line :
City : VERONA
State : NJ
Zip : 07044-1730
Country : US
Telephone Number : 973-559-3700
Fax Number : 833-484-1686
Provider Business Practice Location Address
First Line : 200 HIGHLAND AVE STE 100B
Second Line :
City : GLEN RIDGE
State : NJ
Zip : 07028-1521
Country : US
Telephone Number : 973-969-3800
Fax Number : 833-488-1213
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2023
Last Update Date : 04/16/2025

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