Provider Demographics
NPI:1740435189
Name:DOMINIANNI, ALYSSA (MSPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DOMINIANNI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:DOMINIANNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:1500 HUDSON ST
Mailing Address - Street 2:APT 12G
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5590
Mailing Address - Country:US
Mailing Address - Phone:201-888-3507
Mailing Address - Fax:
Practice Address - Street 1:292 MADISON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6307
Practice Address - Country:US
Practice Address - Phone:201-888-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023394-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics