Provider Demographics
NPI:1760589824
Name:DOMSKY, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:DOMSKY
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 1:90 MATAWAN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2653
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:1801 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1036
Practice Address - Country:US
Practice Address - Phone:609-208-8969
Practice Address - Fax:833-606-0167
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039559L207LP2900X
NJ25MA06304600207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7193301Medicaid
NJP2018305OtherOXFORD
NJ050053129OtherRR MEDICARE
NJ1092942OtherHORIZON NJ HEALTH
NJ010003814OtherAMERICHOICE
NJ26030OtherUNIVERISTY HREALTH PLAN
NJ000843328OtherAMERIHEALTH PPO/PA BS
NJP3109472OtherOXFORD
NJ0876020000OtherAMERIHEALTH/KEYSTONE/IBC
NJ1081261OtherHORIZON NJ HEALTH
NJ000843328OtherAMERIHEALTH PPO/PA BS
NJ050053129OtherRR MEDICARE
NJ26030OtherUNIVERISTY HREALTH PLAN