Individual
CARLOS DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
622 W 168TH ST, AIM CLINIC VC2, NEW YORK, NY 10032-3720
(212) 305-6262
Mailing address
140 HEPBURN RD, APT 5M, CLIFTON, NJ 07012-2231
(201) 478-2205
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
337744
NY
Other
Enumeration date
09/09/2013
Last updated
08/20/2014
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