Provider Demographics
NPI:1760495816
Name:DOMAJNKO, BASTIAN (MD)
Entity type:Individual
Prefix:
First Name:BASTIAN
Middle Name:
Last Name:DOMAJNKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RED CREEK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4300
Mailing Address - Country:US
Mailing Address - Phone:585-244-5670
Mailing Address - Fax:585-359-3907
Practice Address - Street 1:600 RED CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4300
Practice Address - Country:US
Practice Address - Phone:585-244-5670
Practice Address - Fax:585-359-3907
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117665208600000X, 208C00000X
390200000X
NY248932208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program