Provider Demographics
NPI:1235757485
Name:DOMINION HEALTH
Entity Type:Organization
Organization Name:DOMINION HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:AROWOLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:201-887-0029
Mailing Address - Street 1:245 BAYVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1050
Mailing Address - Country:US
Mailing Address - Phone:201-887-0029
Mailing Address - Fax:
Practice Address - Street 1:245 BAYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1050
Practice Address - Country:US
Practice Address - Phone:201-887-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty