Provider Demographics
NPI:1871345868
Name:MD HEALTH GROUP LLC
Entity type:Organization
Organization Name:MD HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-956-9364
Mailing Address - Street 1:1 KARL PL APT 22
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1641
Mailing Address - Country:US
Mailing Address - Phone:973-955-8836
Mailing Address - Fax:
Practice Address - Street 1:680 BROADWAY STE 205
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1527
Practice Address - Country:US
Practice Address - Phone:201-839-3834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1801834429OtherANESTHESIOLOGY/ PAIN MANAGEMENT