Provider Demographics
NPI:1942546585
Name:DI CARMINE, DOMINIQUE BRIANNA (LMT)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:BRIANNA
Last Name:DI CARMINE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 BAILEYS GAP RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2301
Mailing Address - Country:US
Mailing Address - Phone:845-656-4534
Mailing Address - Fax:
Practice Address - Street 1:39 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2006
Practice Address - Country:US
Practice Address - Phone:845-750-6913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-01
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist