Provider Demographics
NPI:1508162785
Name:DOMINION HEALTH INC.
Entity Type:Organization
Organization Name:DOMINION HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:PELLMUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-436-0037
Mailing Address - Street 1:5001A 15TH AVE.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-436-0037
Mailing Address - Fax:718-853-3269
Practice Address - Street 1:109 517TH ST
Practice Address - Street 2:SUITE 25
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:718-436-0037
Practice Address - Fax:718-853-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty