Provider Demographics
NPI:1801118013
Name:APURA, DOMINADOR DOROMAL JR (LMT, PTA)
Entity type:Individual
Prefix:MR
First Name:DOMINADOR
Middle Name:DOROMAL
Last Name:APURA
Suffix:JR
Gender:M
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WAHL AVE
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1350
Mailing Address - Country:US
Mailing Address - Phone:516-239-2934
Mailing Address - Fax:
Practice Address - Street 1:160 WAHL AVE
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1350
Practice Address - Country:US
Practice Address - Phone:516-239-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003541-1225200000X
NY023447-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant