Provider Demographics
NPI:1609380062
Name:DOMANTOVSKAYA, ARINA (CF SLP)
Entity Type:Individual
Prefix:
First Name:ARINA
Middle Name:
Last Name:DOMANTOVSKAYA
Suffix:
Gender:F
Credentials:CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 35TH ST APT 12F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4219
Mailing Address - Country:US
Mailing Address - Phone:917-660-5417
Mailing Address - Fax:
Practice Address - Street 1:40 IRVING PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2305
Practice Address - Country:US
Practice Address - Phone:646-790-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty