MEDICARE: JACOB DOMINIK MD

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	104326	MN
2	2084N0400X	Neurology Physician	52196	MN
3	2084N0400X	Neurology Physician	104326	MN
4	2084N0400X	Neurology Physician	ME98936	FL
5	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	257520	NY
6	2084N0400X	Neurology Physician	257520	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00804268	OTHER	MN	MEDICARE - RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P010257520	OTHER	NY	EXCELLUS

General Provider Information

NPI Number	:	1629233861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB DOMINIK MD

Provider Business Mailing Address
First Line	:	755 JEFFERSON RD
Second Line	:	STE 110
City	:	ROCHESTER
State	:	NY
Zip	:	14623-3233
Country	:	US
Telephone Number	:	585-419-7948
Fax Number	:	585-385-6071

Provider Business Practice Location Address
First Line	:	755 JEFFERSON RD
Second Line	:	STE 110
City	:	ROCHESTER
State	:	NY
Zip	:	14623-3233
Country	:	US
Telephone Number	:	585-419-7948
Fax Number	:	585-385-6071

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	09/13/2022

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Directions to “ JACOB DOMINIK MD” Practice Location

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