Provider Demographics
NPI:1417162231
Name:DOMPREH, RITA A (NP)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:A
Last Name:DOMPREH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TIBBITS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2438
Mailing Address - Country:US
Mailing Address - Phone:914-287-7200
Mailing Address - Fax:914-287-7278
Practice Address - Street 1:12 TIBBITS AVENUE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606
Practice Address - Country:US
Practice Address - Phone:914-287-7200
Practice Address - Fax:914-287-7278
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340657-1363LG0600X
NYF304545363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health