MEDICARE: DAVID L. DONDERO

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	MD001022	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1497811590	OTHER	NJ	NPI SOLE PRACTICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548415169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID L. DONDERO

Provider Business Mailing Address
First Line	:	2304 US HIGHWAY 1
Second Line	:
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-4411
Country	:	US
Telephone Number	:	609-695-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 US HIGHWAY 1
Second Line	:
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-4411
Country	:	US
Telephone Number	:	609-695-6680
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID LEE DONDERO
Credential	:	DPM
Telephone Number	:	609-695-6680

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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Directions to “DAVID L. DONDERO ” Practice Location

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