Jan, Dominique M.

Jan, Dominique M. is an individual health care provider with primary practice located at 3355 Bainbridge Ave , Bronx NY 10467-2801. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Transplant Surgery, Allopathic & Osteopathic Physicians / Pediatric Surgery. Allopathic & Osteopathic Physicians / Pediatric Surgery is his primary health care specialty. Jan, Dominique M. can be contacted via phone (718) 920-7200.

Contact Information

Primary practice address
3355 Bainbridge Ave Bronx NY 10467-2801
Phone: (718) 920-7200
Fax: (718) 547-2929
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Transplant Surgery 204F00000X 0024381 New York
Allopathic & Osteopathic Physicians / Pediatric Surgery 2086S0120X 250182 New York

Profile Details

NPI number 1790726982
LBN Legal business name Jan, Dominique M.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Jan 19th, 2012 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790726982 NPPES
New York MEDICAID 02729091

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