Individual
DOMINIQUE JEAN LOGUIDICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
113 W ESSEX ST STE 204, MAYWOOD, NJ 07607-1023
(201) 289-5551
Mailing address
113 W ESSEX ST STE 204, MAYWOOD, NJ 07607-1023
(201) 289-5551
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
25MP00631600
NJ
363AS0400X
Surgical Physician Assistant
Primary
25MP00631600
NJ
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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