Co, Dominador
Co, Dominador is an individual health care provider with primary practice located at 175 Madison Ave , Mount Holly NJ 08060-2038. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Co, Dominador can be contacted via phone (609) 914-6180.Contact Information
Primary practice address
175 Madison Ave
Mount Holly NJ 08060-2038
Phone: (609) 914-6180
Fax: (609) 914-6182
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 25MA04218400 | New Jersey |
Profile Details
| NPI number | 1598753642 |
|---|---|
| LBN Legal business name | Co, Dominador |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 12th, 2005 |
| Last updated | Sep 1st, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598753642 | NPPES |
| New Jersey | MEDICAID | 0642509 |
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