Dominique Noelle Phillips

Primary specialty

SpecialistTaxonomy code 174400000X

License

1922630383 Issued in NY

Practice address

500 Bi County Blvd Ste 450
Farmingdale, NY 11735-3995

Phone

(718) 264-1640

NPI assigned

Feb 4, 2020

Last updated

Mar 28, 2024By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• New York Therapy Placement Services Inc

  • Community/Behavioral Health Agency
  • Farmingdale, NY
  • NPI 1548708118
  NPD (past)
• New York Therapy Placement Services Inc.

  • Early Intervention Provider Agency
  • Port Jefferson Station, NY
  • NPI 1558507210
  NPD (past)

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1922630383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2146 BARNES AVE APT 305",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104621954",
            "telephone_number": "315-975-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 BI COUNTY BLVD STE 450",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117353995",
            "telephone_number": "718-264-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "DOMINIQUE",
        "middle_name": "NOELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-04",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1922630383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerrick Peters
• Tiffany Peterson
• Kathleen Petrullo, PT
• Craig Pezzillo, R.P.H.
• Pharmacy4Humanity (AHF Pharmacy)
• Phoenix Eastern Acupuncture (Phoenix Eastern Medicine Center)
• Erin M Pia
• Laura Picarelli
• Michelle Irene Pichichero
• Bryan Picozzi, MSW

• Specialist in Farmingdale, NY
• Providers in Farmingdale, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.