MEDICARE: DR. ANTHONY NICHOLAS DONATELLI JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME122358	FL
2	207Q00000X	Family Medicine Physician	167827	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730176793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY NICHOLAS DONATELLI JR. MD

Provider Business Mailing Address
First Line	:	43 BROADWAY AVE
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-1601
Country	:	US
Telephone Number	:	631-603-3770
Fax Number	:	631-251-7020

Provider Business Practice Location Address
First Line	:	43 BROADWAY AVE
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-1601
Country	:	US
Telephone Number	:	631-603-3770
Fax Number	:	631-251-7020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	03/03/2025

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