Provider Demographics
NPI:1225062953
Name:DONAHUE-NEGBAUR, SUSANNAH (CNM)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:DONAHUE-NEGBAUR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SUSANNAH
Other - Middle Name:
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:760 BROADWAY ROOM 2B230 DEPARTMENT OF MANAGED CARE
Mailing Address - Street 2:WOODHULL MEDICAL & MENTAL HEALTH CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-630-8000
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:WOODHULL MEDICAL & MENTAL HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-630-8000
Practice Address - Fax:718-630-3122
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001171163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02640182Medicaid
NYM8M67Medicare ID - Type Unspecified