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General NPI Number Information
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NPI Number | 1548415169
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Entity Type | Organization
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Legal Business Name | DAVID L. DONDERO
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 2304 US HIGHWAY 1
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-4411
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Country | US
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Telephone | 609-695-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 2304 US HIGHWAY 1
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-4411
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Country | US
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Telephone | 609-695-6680
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID LEE DONDERO
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Credential | DPM
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Telephone | 609-695-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MD001022
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License Number State | NJ
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