| Doctor Name: | DR. DOMINIC PETER DIVINCENZO |
| NPI Number: | 1962637975 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 086467 |
| Business Practice Address: | 3604 Big Ridge Rd Spencerport, NY - 145591710 |
| Business Phone Number: | 5853526973 |
| Business Fax Number: | |
| Mailing Address: | 3604 Big Ridge Rd, SPENCERPORT |
| State: | NY |
| Postal Code: | 145591710 |
| Phone Number: | 5853526973 |
| Fax Number: | |
| NPI Enumeration Date: | 05/19/2009 |
| NPI Last Update Date: | 05/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 086467 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |