Healthcare Provider Details

I. General information

NPI: 1417861931
Provider Name (Legal Business Name): DONOVAN DOSSOUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 US HIGHWAY 46 STE 420
FAIRFIELD NJ
07004-1532
US

IV. Provider business mailing address

700 US HIGHWAY 46
FAIRFIELD NJ
07004-1591
US

V. Phone/Fax

Practice location:
  • Phone: 412-973-6359
  • Fax:
Mailing address:
  • Phone: 302-753-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: