| Doctor Name: | DR. MANUEL I DOMINGO |
| NPI Number: | 1427266303 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 121456 |
| Business Practice Address: | 144 Beach 111 St. Rockaway Park, NY - 11694 |
| Business Phone Number: | 7189452800 |
| Business Fax Number: | |
| Mailing Address: | 256 New Hyde Park Rd, GARDEN CITY |
| State: | NY |
| Postal Code: | 115302326 |
| Phone Number: | 5163545904 |
| Fax Number: | |
| NPI Enumeration Date: | 05/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0804X |
| License Number: | 121456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Child & Adolescent Psychiatry |
| Taxonomy Definition: | Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |