Individual
DR. DOMINIQUE M. JAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3355 BAINBRIDGE AVE, BRONX, NY 10467-2801
(718) 920-7200
(718) 547-2929
Mailing address
3355 BAINBRIDGE AVE, BRONX, NY 10467-2801
(718) 920-7200
(718) 547-2929
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
0024381
NY
2086S0120X
Pediatric Surgery Physician
Primary
250182
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02729091
—
NY
Enumeration date
06/09/2006
Last updated
01/19/2012
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