Provider Demographics
NPI:1083677553
Name:SANTO DOMINGO, NORMAN EUSTAQUIO (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:EUSTAQUIO
Last Name:SANTO DOMINGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROUTE 9
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-3068
Mailing Address - Country:US
Mailing Address - Phone:732-269-4100
Mailing Address - Fax:732-269-2356
Practice Address - Street 1:800 ROUTE 9
Practice Address - Street 2:SUITE 4
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-3068
Practice Address - Country:US
Practice Address - Phone:732-269-4100
Practice Address - Fax:732-269-2356
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04522900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics