Provider Demographics
NPI:1639101272
Name:HUTTON-CASSIE, DONNA P (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:P
Last Name:HUTTON-CASSIE
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 1:232 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1855
Mailing Address - Country:US
Mailing Address - Phone:973-477-1921
Mailing Address - Fax:973-672-5101
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:201-867-9183
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069099208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8085102Medicaid
NJ8085102Medicaid
NJH07844Medicare UPIN