Individual
NINO DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
459 PASSAIC AVE, WEST CALDWELL, NJ 07006-7457
(973) 276-7887
Mailing address
15 DIXON PL, EAST HANOVER, NJ 07936-3049
(973) 960-1383
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00439400
NJ
Other
Enumeration date
10/26/2010
Last updated
10/26/2010
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