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NPI Code Detail

MEDICARE: DR. GERARD DONOHUE PHD

MEDICARE: DR. GERARD DONOHUE PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist35SI00159100NJ
2103T00000XPsychologist35SI00159100NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205824349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERARD DONOHUE PHD
Provider Business Mailing Address
First Line : 100 PROSPECT AVE
Second Line : APT 4J
City : HACKENSACK
State : NJ
Zip : 07601-1959
Country : US
Telephone Number : 201-370-5545
Fax Number : 717-975-9981
Provider Business Practice Location Address
First Line : 300 MARKET STREET
Second Line : KESSLER INSTITUTE FOR PHYSICAL REHABILITATION
City : SADDLE BROOK
State : NJ
Zip : 07663-5309
Country : US
Telephone Number : 201-370-5545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 12/21/2018

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