Provider Demographics
NPI:1407811839
Name:COLAVITA, DONATO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:DONATO
Middle Name:ANTONIO
Last Name:COLAVITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2142
Mailing Address - Country:US
Mailing Address - Phone:973-344-6897
Mailing Address - Fax:973-344-3854
Practice Address - Street 1:253 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2142
Practice Address - Country:US
Practice Address - Phone:973-344-6897
Practice Address - Fax:973-344-3854
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40963208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2058804Medicaid
C55775Medicare UPIN
NJ2058804Medicaid