Provider Demographics
NPI:1619203742
Name:DONNIS, GREGORY E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:DONNIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:971 ROUTE 45
Practice Address - Street 2:SUITE 216
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3500
Practice Address - Country:US
Practice Address - Phone:551-427-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-24
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017721-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist