Healthcare Provider Details

I. General information

NPI: 1942092440
Provider Name (Legal Business Name): DONNA GEDEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHAMPLIN ST
RONKONKOMA NY
11779-1802
US

IV. Provider business mailing address

12 WATER ST STE 401
WHITE PLAINS NY
10601-1401
US

V. Phone/Fax

Practice location:
  • Phone: 347-476-7544
  • Fax:
Mailing address:
  • Phone: 914-216-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number866864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: