Provider Demographics
NPI:1407893647
Name:DONNELLEY, NAOMI (MD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:DONNELLEY
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 1:277 W END AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2605
Mailing Address - Country:US
Mailing Address - Phone:212-769-0069
Mailing Address - Fax:212-769-0075
Practice Address - Street 1:277 W END AVE APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2605
Practice Address - Country:US
Practice Address - Phone:212-769-0069
Practice Address - Fax:212-769-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215121207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112253Medicaid
I26485Medicare UPIN
IL036-112253Medicaid