Individual
JOSEFINA TAN- DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7785 N STATE ST, SUITE 210, LOWVILLE, NY 13367-1229
(315) 376-5475
(315) 376-5129
Mailing address
7785 N STATE ST STE 210, LOWVILLE, NY 13367-1229
(315) 376-5475
(315) 376-5129
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
115469
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00641736
—
NY
Enumeration date
08/23/2006
Last updated
07/21/2016
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