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General NPI Number Information
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NPI Number | 1477080588
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Entity Type | Individual
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Provider Name | JACOB DONOHUE DMD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 30 E 40TH ST RM 608
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 212-251-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 66 SEABREEZE LN
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City | BRISTOL
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State | RI
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Zip | 02809-1552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 059871
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License Number State | NY
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