Provider Demographics
NPI:1023835352
Name:AGUILAR, DOMINIQUE ELIANA (FNP)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ELIANA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 OLD AMBOY RD APT 205
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3478
Mailing Address - Country:US
Mailing Address - Phone:917-355-7169
Mailing Address - Fax:
Practice Address - Street 1:501 SEAVIEW AVE STE 104
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3400
Practice Address - Country:US
Practice Address - Phone:718-226-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily