Organization
ELVITA GENELUS-DOMINIQUE, D.O, F.A.C.S, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELVITA GENELUS-DOMINIQUE DO (OWNER)
(516) 721-5168
Entity
Organization
Contact information
Practice address
5850 CATALPA AVE, RIDGEWOOD, NY 11385-5028
(718) 821-1910
(718) 821-1125
Mailing address
628 LENORE LN, ELMONT, NY 11003-4526
(516) 721-5168
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03244057
—
NY
Enumeration date
03/07/2019
Last updated
03/07/2019
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