Odeilis Maxiel Dominguez Amadiz, MD

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

25MA10860700 Issued in NJ

Practice address

234 E 149TH St
Bronx, NY 10451-5504

Phone

(718) 579-5000

NPI assigned

Jul 6, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: odominguez47857@epicdirect.rwjbh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Specialized Hospital

  • Children's Rehabilitation Hospital
  • New Brunswick, NJ
  • NPI 1396886297
  Medicare reassignment NPD
• Children' Specialized Hospital

  • Medically Fragile Infants and Children Day Care
  • Mountainside, NJ
  • NPI 1578604476
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1821519331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515504",
            "telephone_number": "718-579-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515504",
            "telephone_number": "718-579-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ AMADIZ",
        "first_name": "ODEILIS",
        "middle_name": "MAXIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-06",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NJ",
            "license": "25MA10860700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melchor Torres Domingo, M.D.
• Michelle C Domingo, NP
• Rodellee Valdez Domingo
• Rui Barreira Domingues, M.D.
• Edwin A Dominguez Almonte, M.D
• Sarasuati Devi Dominguez Jimenez, MD
• Ciomara Dominguez
• Cristina Dominguez, PSY.D.
• Jacob Mauro Dominguez, LPN
• Lorens Dominguez

• Developmental - Behavioral Pediatrics Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Developmental - Behavioral Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.