Provider Demographics
NPI:1316479728
Name:DOMINGO, ANNA THERESE (DO)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:THERESE
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 N FRANKLIN TPKE STE 202
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1385
Mailing Address - Country:US
Mailing Address - Phone:201-236-2100
Mailing Address - Fax:
Practice Address - Street 1:470 N FRANKLIN TPKE STE 202
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1385
Practice Address - Country:US
Practice Address - Phone:201-236-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309964207V00000X
390200000X
NJ25MB11579200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program