MEDICARE: DR. DONNA J.C. FANELLI DNP

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	363LA2100X	Acute Care Nurse Practitioner	26NN06605500	NJ
2	363LA2100X	Acute Care Nurse Practitioner	F430118-1	NY
3	363LA2200X	Adult Health Nurse Practitioner	26NN06605500	NJ
4	363LA2200X	Adult Health Nurse Practitioner	F303208-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3598174	OTHER	NJ	OXFORD
2	2K9125	OTHER	NJ	HEALTH NET
3	286989	OTHER	NJ	AMERIGROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	123	OTHER	NJ	CIGNA
6	2517320	OTHER	NJ	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1750362679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA J.C. FANELLI DNP

Provider Business Mailing Address
First Line	:	ADVANTAGECARE PHYSICIANS, PC
Second Line	:	55 WATER STREET 2ND FLOOR CRED DEPT
City	:	NEW YORK
State	:	NY
Zip	:	10041-0004
Country	:	US
Telephone Number	:	646-680-2888
Fax Number	:	516-542-5556

Provider Business Practice Location Address
First Line	:	120 PARK AVE
Second Line	:	LOWER LEVEL C
City	:	NEW YORK
State	:	NY
Zip	:	10017-5577
Country	:	US
Telephone Number	:	646-324-9461
Fax Number	:	646-324-1020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	12/02/2019

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