Active NPI
Mark A. Dominguez, MA. PSYA
- Psychoanalyst
- Teaneck, NJ
National Provider Identifier
1831765320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalyst
- Practice address
- 800 Catalpa Ave
Teaneck, NJ 07666 - Phone
- (201) 641-5648
- Fax
- (201) 440-8580
- NPI assigned
- Jun 3, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | Primary |
Addresses
Primary practice location
800 Catalpa Ave
Teaneck, NJ 07666
Mailing address
250 Euclid Ave
Ridgefield PK, NJ 07660
Phone (201) 641-5648
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622678400000",
"number": "1831765320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 EUCLID AVE",
"city": "RIDGEFIELD PK",
"state": "NJ",
"postal_code": "07660",
"telephone_number": "201-641-5648",
"fax_number": "201-440-8580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 CATALPA AVE",
"city": "TEANECK",
"state": "NJ",
"postal_code": "07666",
"telephone_number": "201-641-5648",
"fax_number": "201-440-8580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "MARK",
"middle_name": "A.",
"credential": "MA. PSYA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-03",
"last_updated": "2021-06-03",
"certification_date": "2021-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.