Domanick, Thomas M

Domanick, Thomas M is an individual health care provider with primary practice located at 1825 Barnum Ave , Stratford CT 06614-5333. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Foot Surgery. Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine is his primary health care specialty. Domanick, Thomas M can be contacted via phone (203) 377-1777.

Contact Information

Primary practice address
1825 Barnum Ave Stratford CT 06614-5333
Phone: (203) 377-1777
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine 213EP1101X P00289 Connecticut
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X P00289 Connecticut

Profile Details

NPI number 1629012661
LBN Legal business name Domanick, Thomas M
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Jan 7th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629012661 NPPES
Connecticut MEDICAID 004051868
Connecticut Other 0V2746
Connecticut Other ZS701
Connecticut Other 004144309
Connecticut Other 0V2746
Connecticut Other 0071014
Connecticut Other 030000289CT02

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