Individual provider · Type 1 NPI

Johnathan Mark Domenico, PA-C

Physician Assistant · Potsdam, NY

NPI number 1346163367 Active

Practice location

8 Clarkson Ave
Potsdam, NY 13699-1401

Call (315) 268-2161 Map

Mailing address

7134 Rickmeyer Rd
Rome, NY 13440-6342

Specialties and licenses

Taxonomy	Code	License
Physician Assistant Primary	363A00000X	None listed

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1346163367

Johnathan Mark Domenico, PA-C's National Provider Identifier is 1346163367, issued on Aug 4, 2026. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Potsdam, NY. The record was last updated on Aug 4, 2026.