Individual
MISS DOMINIQUE ELIZABETH DE MATTEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
108 SIDEVIEW AVE, STATEN ISLAND, NY 10314-3253
(718) 873-6019
Mailing address
108 SIDEVIEW AVE, STATEN ISLAND, NY 10314-3253
(718) 873-6019
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
344046
NY
Other
Enumeration date
03/29/2020
Last updated
03/29/2020
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