Provider Demographics
NPI:1417094228
Name:MAGBALON, DOMINGO F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:F
Last Name:MAGBALON
Suffix:JR
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 1:1656 BLUE JAY LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3102
Mailing Address - Country:US
Mailing Address - Phone:856-428-2448
Mailing Address - Fax:
Practice Address - Street 1:1656 BLUE JAY LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3102
Practice Address - Country:US
Practice Address - Phone:856-428-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ34818146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant