Provider Demographics
NPI:1619214814
Name:MCCABE, DONNA E
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:MCCABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 25TH ST
Mailing Address - Street 2:APT 18C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3001
Mailing Address - Country:US
Mailing Address - Phone:917-748-6156
Mailing Address - Fax:
Practice Address - Street 1:6110 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5776
Practice Address - Country:US
Practice Address - Phone:212-609-1745
Practice Address - Fax:646-524-8337
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476577163W00000X
NY340549363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse