Healthcare Provider Details

I. General information

NPI: 1982696985
Provider Name (Legal Business Name): DONALD A MACDONALD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N GILBERT ST SUITE 200
TINTON FALLS NJ
07701-4913
US

IV. Provider business mailing address

21N GILBERT ST SUITE 200
TINTON FALLS NJ
07701-4913
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-1902
  • Fax: 732-741-1919
Mailing address:
  • Phone: 732-741-1902
  • Fax: 732-741-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA04441400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: