Healthcare Provider Details

I. General information

NPI: 1356791503
Provider Name (Legal Business Name): JAD A DONATO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 03/06/2024
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 PARK STREET SUITE 200
HACKENSACK NJ
07601-4350
US

IV. Provider business mailing address

PO BOX 1447
ENGLEWOOD NJ
07632-1447
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-8510
  • Fax: 201-957-7316
Mailing address:
  • Phone: 201-546-8510
  • Fax: 201-957-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11086800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier25MA11086800
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: