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General NPI Number Information
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NPI Number | 1194968883
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Entity Type | Organization
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Legal Business Name | EAST COAST ELECTRODIAGNOSTIC, INC.
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Dates
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Enumeration Date | 04/11/2009
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Last Update Date | 04/11/2009
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Provider Practice Location Address
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Address Line | 118 COTTAGE AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02911-3545
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Country | US
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Telephone | 401-499-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 118 COTTAGE AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02911-3545
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Country | US
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Telephone | 401-499-6772
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY DONATELLI
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Credential |
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Telephone | 401-499-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 238278
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License Number State | MA
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