Provider Demographics
NPI:1578903720
Name:DR DONNA LOKETCH
Entity Type:Organization
Organization Name:DR DONNA LOKETCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-309-3321
Mailing Address - Street 1:11 MEDICAL PARK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3559
Mailing Address - Country:US
Mailing Address - Phone:914-588-1035
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:914-588-1035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty