Provider Demographics
NPI:1528392768
Name:DONALDSON, CARL JOSEPH JR (ND, LMT)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JOSEPH
Last Name:DONALDSON
Suffix:JR
Gender:M
Credentials:ND, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BOWER ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2504
Mailing Address - Country:US
Mailing Address - Phone:908-612-4931
Mailing Address - Fax:
Practice Address - Street 1:1445 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-4013
Practice Address - Country:US
Practice Address - Phone:908-612-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00129200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist