Healthcare Provider Details

I. General information

NPI: 1003989625
Provider Name (Legal Business Name): DONNA P PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE NBV21W87
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE NBV21W87
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-2611
  • Fax: 212-263-8217
Mailing address:
  • Phone: 212-263-2611
  • Fax: 212-263-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number175363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: