Provider Demographics
NPI:1922281872
Name:DANIEL L. DOMBROSKI, M.D., P.C.
Entity Type:Organization
Organization Name:DANIEL L. DOMBROSKI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-488-5588
Mailing Address - Street 1:PHYSICIANS OFFICE BLDG. N. STE. 4U
Mailing Address - Street 2:COMMUNITY GENERAL HOSPITAL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215
Mailing Address - Country:US
Mailing Address - Phone:315-492-5777
Mailing Address - Fax:315-492-5892
Practice Address - Street 1:PHYSICIANS OFFICE BLDG. N. STE. 4U
Practice Address - Street 2:COMMUNITY GENERAL HOSPITAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-5777
Practice Address - Fax:315-492-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086934-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00560921Medicaid
NY00560921Medicaid
NY32154BMedicare PIN