Basic Information
| Provider Information | |||||||||
| NPI: | 1659356426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONIS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | FRANKLYN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28064 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100878064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145937880 | ||||||||
| FaxNumber: | 9145937881 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 E HARTSDALE AVE | ||||||||
| Address2: | |||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105303544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147252010 | ||||||||
| FaxNumber: | 9147256488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 002361 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0131X | 002361 | NY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | A100000178 | 01 | NY | PTAN | OTHER | 00416500 | 05 | NY | MEDICAID | A400028366 | 01 | NY | MEDICARE PTAN | OTHER |