Individual
DOMINICK FEDERICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
600 RIVER AVENUE, LAKEWOOD, NJ 08701
(732) 363-1900
Mailing address
600 RIVER AVENUE, LAKEWOOD, NJ 08701
(732) 363-1900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00285300
NJ
Other
Enumeration date
07/18/2012
Last updated
07/18/2012
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