Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 310253 | NY |
NPI | 1225488596 |
---|---|
Provider Name | Marissa Dombovy-Johnson |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14626-4296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 02/09/2021 |