Provider Demographics
NPI:1598420853
Name:VENEZIANO, DOMENICO (MD)
Entity Type:Individual
Prefix:
First Name:DOMENICO
Middle Name:
Last Name:VENEZIANO
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 1:733 SUNRISE HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2910
Mailing Address - Country:US
Mailing Address - Phone:516-927-1500
Mailing Address - Fax:
Practice Address - Street 1:733 SUNRISE HWY FL 2
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2910
Practice Address - Country:US
Practice Address - Phone:516-927-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31190201208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology