Provider Demographics
NPI:1700960333
Name:DELMA, DOMINIQUE (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:DELMA
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 1:1 FOXHALL AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5107
Mailing Address - Country:US
Mailing Address - Phone:845-338-8444
Mailing Address - Fax:845-338-2906
Practice Address - Street 1:1 FOXHALL AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5107
Practice Address - Country:US
Practice Address - Phone:845-338-8444
Practice Address - Fax:845-338-2906
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0025522207V00000X
NJ25MA11699300207V00000X
NY206186-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01752487Medicaid
G53428Medicare UPIN
NY01752487Medicaid