Individual provider · NPI-1
Marc Domingo, PTA
Physical Medicine & Rehabilitation · Babylon, NY
NPI number1790473940
StatusActive
Last updated in NPPESApr 26, 2023
Details
- NPI
- 1790473940
- Entity type
- Individual (NPI-1)
- Name
- Marc Domingo
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 26, 2023
- Certification date
- Apr 26, 2023
- Last updated
- Apr 26, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 013504 | NY | Yes |
Practice location
1026 Little East Neck RdBabylon, NY 11704-2411
Phone 631-560-4548
Mailing address
1026 Little East Neck RdBabylon, NY 11704-2411
Phone 631-560-4548
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