Individual
MR. CHRISTOPHER JAMES DOMINIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
15 MARLBORO AVE, N MASSAPEQUA, NY 11758-2429
(516) 557-3254
Mailing address
15 MARLBORO AVE, N MASSAPEQUA, NY 11758-2429
(516) 541-8919
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
012547-1
NY
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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