Healthcare Provider Details

I. General information

NPI: 1801282736
Provider Name (Legal Business Name): BRIAN ANTHONY DONATELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BEATRICE CT
DIX HILLS NY
11746-5302
US

IV. Provider business mailing address

9 BEATRICE CT
DIX HILLS NY
11746-5302
US

V. Phone/Fax

Practice location:
  • Phone: 332-400-6308
  • Fax: 212-233-2519
Mailing address:
  • Phone: 332-400-6308
  • Fax: 212-233-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number296244
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number296244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: