Healthcare Provider Details

I. General information

NPI: 1265594634
Provider Name (Legal Business Name): ANGELETA DHANDARI-DONOVAN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 KOSSUTH AVE
BRONX NY
10467-2410
US

IV. Provider business mailing address

74 N BICYCLE PATH
SELDEN NY
11784-2242
US

V. Phone/Fax

Practice location:
  • Phone: 718-519-2108
  • Fax:
Mailing address:
  • Phone: 631-696-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: