Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI01971200 | NJ |
Y | 213EG0000X | General Practice | 22DI01971200 | NJ |
NPI | 1003925199 |
---|---|
Provider Name | Dr. Rita Domasica |
First Address | Clinton, NJ 08809-1076 |
Second Address | Clinton, NJ 08809-1076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |