Provider Demographics
NPI:1851539340
Name:DOMANY, CHRISTINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:DOMANY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 WINCHESTER BLVD
Mailing Address - Street 2:BLDG 21 3RD FLOOR
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2193
Mailing Address - Country:US
Mailing Address - Phone:718-479-8395
Mailing Address - Fax:718-465-1947
Practice Address - Street 1:8045 WINCHESTER BLVD
Practice Address - Street 2:BLDG 21 3RD FLOOR
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2193
Practice Address - Country:US
Practice Address - Phone:718-479-8395
Practice Address - Fax:718-465-1947
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01035285Medicaid