Provider Demographics
NPI:1295839231
Name:LOKETCH, DONNA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:LOKETCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:FRANKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:453-680-1008
Mailing Address - Fax:845-368-3806
Practice Address - Street 1:222 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-354-0510
Practice Address - Fax:845-354-0629
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241048207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001850Medicare PIN