Healthcare Provider Details

I. General information

NPI: 1639628613
Provider Name (Legal Business Name): MAUREEN THERESA DONOHUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2016
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E 149TH ST
BRONX NY
10451-5601
US

IV. Provider business mailing address

191 73RD ST APT 257
BROOKLYN NY
11209-2257
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-2698
  • Fax: 718-943-7035
Mailing address:
  • Phone: 315-573-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1186746171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: