Provider Demographics
NPI:1568507788
Name:DONNELLY, ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:DONNELLY
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 1:7906 35TH AVE APT 4N
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2720
Mailing Address - Country:US
Mailing Address - Phone:718-205-5012
Mailing Address - Fax:718-205-5012
Practice Address - Street 1:590 AVENUE OF THE AMERICAS
Practice Address - Street 2:MEDICAL OFFICE 1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2019
Practice Address - Country:US
Practice Address - Phone:212-886-4097
Practice Address - Fax:212-206-4161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240794OtherMEDICAL LICENSE