Basic Information
| Provider Information | |||||||||
| NPI: | 1003832627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONIN | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3765 RIVERDALE AVE | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104631845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186012700 | ||||||||
| FaxNumber: | 7186019890 | ||||||||
| Practice Location | |||||||||
| Address1: | 3765 RIVERDALE AVE | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104631845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186012700 | ||||||||
| FaxNumber: | 7186019890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 151945 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01014671 | 05 | NY | MEDICAID | 3C1766 | 01 | NY | HEALTH NET | OTHER | WP666 | 01 | NY | OXFORD | OTHER | 2554370 | 01 | NY | AETNA HMO | OTHER | 27821P | 01 | NY | HIP | OTHER | 5861192 | 01 | NY | AETNA PPO | OTHER | 84399 | 01 | NY | NYLCARE | OTHER | 134177588 | 01 | NY | 1199 | OTHER | 3C1766 | 01 | NY | PHS/HEALTHNET | OTHER | WAA851 | 01 | NY | MEDICARE | OTHER | 134177588 | 01 | NY | UNITED HEALTH CARE | OTHER | 54C60 | 01 | NY | EMPIRE BC/BS PPO | OTHER | RR MEDICARE | 01 | NY | RAILROAD MEDICARE | OTHER |