Individual
MR. JUAN C DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24 BERKLEY RD, MINEOLA, NY 11501-4604
(516) 274-0606
Mailing address
24 BERKLEY RD, MINEOLA, NY 11501-4604
(516) 274-0606
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
204552
NY
Other
Enumeration date
01/09/2026
Last updated
01/09/2026
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