Provider Demographics
NPI:1205824349
Name:DONOHUE, GERARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PROSPECT AVE
Mailing Address - Street 2:APT 4J
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1959
Mailing Address - Country:US
Mailing Address - Phone:201-370-5545
Mailing Address - Fax:717-975-9981
Practice Address - Street 1:300 MARKET STREET
Practice Address - Street 2:KESSLER INSTITUTE FOR PHYSICAL REHABILITATION
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5309
Practice Address - Country:US
Practice Address - Phone:201-370-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00159100103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051373Medicaid
NY192353Medicare ID - Type Unspecified