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General NPI Number Information
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NPI Number | 1578903720
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Entity Type | Organization
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Legal Business Name | DR DONNA LOKETCH
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 11 MEDICAL PARK DR STE 100
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City | POMONA
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State | NY
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Zip | 10970-3559
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Country | US
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Telephone | 914-588-1035
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MEDICAL PARK DR STE 100
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City | POMONA
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State | NY
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Zip | 10970-3559
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Country | US
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Telephone | 914-588-1035
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | MR. MARK BRAUN
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Credential |
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Telephone | 718-309-3321
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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 | 241048
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License Number State | NY
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