Provider Demographics
NPI:1376812354
Name:DOMB, CLAUDIA (RN)
Entity type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:
Last Name:DOMB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 JACKSON AVE
Mailing Address - Street 2:WILLIS AVE SCHOOL
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2709
Mailing Address - Country:US
Mailing Address - Phone:516-237-2980
Mailing Address - Fax:516-237-2908
Practice Address - Street 1:121 JACKSON AVE
Practice Address - Street 2:WILLIS AVE SCHOOL
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2709
Practice Address - Country:US
Practice Address - Phone:516-237-2980
Practice Address - Fax:516-237-2908
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY364606163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse