Healthcare Provider Details

I. General information

NPI: 1376580662
Provider Name (Legal Business Name): DONNA P SEMINARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LYNDALE AVE
STATEN ISLAND NY
10312-6131
US

IV. Provider business mailing address

420 LYNDALE AVE
STATEN ISLAND NY
10312-6131
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-5630
  • Fax: 718-967-7099
Mailing address:
  • Phone: 718-967-5630
  • Fax: 718-967-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number179723
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number179723
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number179723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: