Individual
CARLIE ANN DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(973) 886-8521
Mailing address
14 SUNSET DR, WHIPPANY, NJ 07981-1620
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00904600
NJ
Other
Enumeration date
01/07/2025
Last updated
01/07/2025
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