Provider Demographics
NPI:1326168873
Name:MIGNONE, DOMENICO (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:MIGNONE
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 1:955 YONKERS AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3060
Mailing Address - Country:US
Mailing Address - Phone:914-776-2778
Mailing Address - Fax:914-776-1274
Practice Address - Street 1:955 YONKERS AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3060
Practice Address - Country:US
Practice Address - Phone:914-776-2778
Practice Address - Fax:914-776-1274
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130267Medicaid
NY01130267Medicaid
NY26F102Medicare ID - Type Unspecified
NY26F103Medicare ID - Type Unspecified
NY26F101Medicare ID - Type Unspecified