Individual
JED MARIE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
701 STATE RT 440 STE 21, JERSEY CITY, NJ 07304-1069
(201) 315-9859
Mailing address
3 ROSE CT FL 2, BAYONNE, NJ 07002-1291
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01782600
NJ
Other
Enumeration date
03/23/2018
Last updated
03/23/2018
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