Basic Information
| Provider Information | |||||||||
| NPI: | 1760589824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMSKY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUTIE 502 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569636888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 FRIENDS LN STE 101 | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557272465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MA63046 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MA63046 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7193301 | 05 | NJ | MEDICAID | P2018305 | 01 | NJ | OXFORD | OTHER | 050053129 | 01 | NJ | RR MEDICARE | OTHER | 1092942 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 010003814 | 01 | NJ | AMERICHOICE | OTHER | 26030 | 01 | NJ | UNIVERISTY HREALTH PLAN | OTHER | 000843328 | 01 | NJ | AMERIHEALTH PPO/PA BS | OTHER | P3109472 | 01 | NJ | OXFORD | OTHER | 0876020000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 1081261 | 01 | NJ | HORIZON NJ HEALTH | OTHER |