Provider Demographics
NPI:1023027463
Name:NUNEZ, DOMINGO CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:CARLOS
Last Name:NUNEZ
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 1:155 EAST 76 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2850
Mailing Address - Country:US
Mailing Address - Phone:212-879-5559
Mailing Address - Fax:212-249-7640
Practice Address - Street 1:155 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2850
Practice Address - Country:US
Practice Address - Phone:212-879-5559
Practice Address - Fax:212-249-7640
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63768Medicare UPIN
NY388I61Medicare ID - Type Unspecified