Provider Demographics
NPI:1417374208
Name:NIEMIEC, DOMINIKA T
Entity Type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:T
Last Name:NIEMIEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6062 69TH PL
Mailing Address - Street 2:MASPETH
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2942
Mailing Address - Country:US
Mailing Address - Phone:646-420-9630
Mailing Address - Fax:
Practice Address - Street 1:6062 69TH PL
Practice Address - Street 2:MASPETH
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2942
Practice Address - Country:US
Practice Address - Phone:646-420-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist