Individual
MS. MARITZA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
101 S BERGEN PLACE, FREEPORT, NY 11520
(516) 623-3600
(516) 623-9191
Mailing address
380 NASSAU RD, LONG ISLAND FQHC, INC., ROOSEVELT, NY 11575-1343
(516) 571-8600
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F303551
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02481836
—
NY
Enumeration date
01/03/2006
Last updated
04/20/2015
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