Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 248489 | NY |
N | 208000000X | Pediatrician | 248489 | NY |
NPI | 1679775068 |
---|---|
Provider Name | Dr. Jacques Regine Domond |
First Address | East Meadow, NY 11554 |
Second Address | Jamaica, NY 11418-2832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 22/12/2014 |