Basic Information
| Provider Information | |||||||||
| NPI: | 1902054778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEFFREY F. DONIS, D.P.M., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 E HARTSDALE AVE | ||||||||
| Address2: | |||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105303544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147252010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 E HARTSDALE AVE | ||||||||
| Address2: | |||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105303544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147252010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 09/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | DONIS | ||||||||
| AuthorizedOfficialFirstName: | ROSEANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 9147252010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | N002361-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00416500 | 05 | NY | MEDICAID |