Healthcare Provider Details

I. General information

NPI: 1649539552
Provider Name (Legal Business Name): DONELLE LESLIE CUMMINGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 5TH AVE # 1CD
NEW YORK NY
10028-0112
US

IV. Provider business mailing address

1056 5TH AVE # 1CD
NEW YORK NY
10028-0112
US

V. Phone/Fax

Practice location:
  • Phone: 646-410-0702
  • Fax: 646-410-0739
Mailing address:
  • Phone: 646-410-0702
  • Fax: 646-410-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number293340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: