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General NPI Number Information
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NPI Number | 1396067591
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Entity Type | Organization
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Legal Business Name | ANTHONY N. DONATELLI JR MD., PC
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 100 HOSPITAL RD SUITE 200
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-8809
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Country | US
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Telephone | 631-730-0406
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 406
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City | BROOKHAVEN
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State | NY
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Zip | 11719-0406
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Country | US
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Telephone | 631-730-0406
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANTHONY N DONATELLI JR.
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Credential | MD.,PC
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Telephone | 631-730-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 167827
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License Number State | NY
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