Provider Demographics
NPI:1306813696
Name:POMPA, DOMINIC ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:ANTHONY
Last Name:POMPA
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 1:1419 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2300
Mailing Address - Country:US
Mailing Address - Phone:718-979-1349
Mailing Address - Fax:718-667-1805
Practice Address - Street 1:177 E 87TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2226
Practice Address - Country:US
Practice Address - Phone:212-423-0691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00202891Medicaid
NY702901Medicare ID - Type Unspecified