Provider Demographics
NPI:1245856111
Name:DOMINGUEZ, SARAH (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 ROUTE 70 STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5897
Mailing Address - Country:US
Mailing Address - Phone:732-364-8000
Mailing Address - Fax:732-364-4601
Practice Address - Street 1:475 ROUTE 70 STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-364-8000
Practice Address - Fax:732-364-4601
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT221576207V00000X
NJ25MA12319600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology