1568451995 NPI number — DENNIS DOMOSI

Table of content: DENNIS DOMOSI (NPI 1568451995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568451995 NPI number — DENNIS DOMOSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMOSI
Provider First Name:
DENNIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568451995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 HIGH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10960-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-353-1441
Provider Business Mailing Address Fax Number:
845-353-1987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 HIGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10960-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-353-1441
Provider Business Practice Location Address Fax Number:
845-353-1987
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1533681 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000075204 . This is a "GHI HMO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 153368 . This is a "HIP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 363522 . This is a "TACONIC IPA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 230544 . This is a "WELLCARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4399282 . This is a "AETNA PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0203731 . This is a "GHI PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3098499 . This is a "OXFORD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100004101 . This is a "AFFINITY HEALTH PLAN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DD3368 . This is a "ATLANTIS HEALTH PLAN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00945253 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0888254 . This is a "AETNA HMO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 675E41 . This is a "EMPIRE BCBS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 153368 . This is a "CONNECTICARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 363522 . This is a "MVP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D3068 . This is a "HEALTHNET #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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