Healthcare Provider Details

I. General information

NPI: 1205824349
Provider Name (Legal Business Name): GERARD DONOHUE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET STREET KESSLER INSTITUTE FOR PHYSICAL REHABILITATION
SADDLE BROOK NJ
07663-5309
US

IV. Provider business mailing address

100 PROSPECT AVE APT 4J
HACKENSACK NJ
07601-1959
US

V. Phone/Fax

Practice location:
  • Phone: 201-370-5545
  • Fax:
Mailing address:
  • Phone: 201-370-5545
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00159100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00159100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: