Provider Demographics
NPI:1235562091
Name:DONOHUE, KRISTEN DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2221
Mailing Address - Country:US
Mailing Address - Phone:732-861-5685
Mailing Address - Fax:
Practice Address - Street 1:110 SOMERSET ST
Practice Address - Street 2:APT 1109
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-4800
Practice Address - Country:US
Practice Address - Phone:732-861-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10234900208600000X, 208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery