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Contact Information

THOMAS M DOMANICK, D.P,M,
1825 BARNUM AVE
STRATFORD, CT06614-5333
 Phone: 203-377-1777
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Podiatric Medicine

213EP1101X 48 Podiatry
 

Surgery, Foot

213ES0131X 48 Podiatry
Indicates primary specialty

NPI Profile & details for THOMAS M DOMANICK · (Male)

NPI Number 1629012661
Status Active
Credentials D.P,M,
Entity Individual
Enumeration date 06/16/2006
Last updated 01/07/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • CT License # P00289
  • CT Medicaid 004051868
  • CT Other 0071014 AETNA
  • CT Other 030000289CT02 ANTHEM BC/BS
  • CT Other 0V2746 HEALTH NET
  • CT Other 0V2746 HEALTH NET SMART CHOICE
  • CT Other 004144309 MEDICAID DME
  • CT Other ZS701 OXFORD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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