Provider Demographics
NPI:1124034897
Name:PAMINTUAN, DOMINIC (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:PAMINTUAN
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:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:569 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3262
Practice Address - Country:US
Practice Address - Phone:732-530-0100
Practice Address - Fax:732-530-5895
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08618100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA611521901OtherUS DEPT OF LABOR
VA611521902OtherUS DEPT OF LABOR
VA611521900OtherUS DEPT OF LABOR
VA611521902OtherUS DEPT OF LABOR
NJ177224DCHMedicare PIN
VA611521901OtherUS DEPT OF LABOR