Provider Demographics
NPI:1942605266
Name:DOMINGUES, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DOMINGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GARIBALDI AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-2110
Mailing Address - Country:US
Mailing Address - Phone:908-247-5776
Mailing Address - Fax:
Practice Address - Street 1:10 GARIBALDI AVE
Practice Address - Street 2:SUITE 34
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2110
Practice Address - Country:US
Practice Address - Phone:908-247-5776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00133800237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MG00133800OtherSTATE OF NEW JERSEY