Provider Demographics
NPI:1538562616
Name:DOMBLOSKI, LOUISA
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:DOMBLOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 WILLOW GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1799
Mailing Address - Country:US
Mailing Address - Phone:908-441-1482
Mailing Address - Fax:908-850-6861
Practice Address - Street 1:651 WILLOW GROVE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1799
Practice Address - Country:US
Practice Address - Phone:908-441-1482
Practice Address - Fax:908-850-6861
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered