Provider Demographics
NPI:1740224377
Name:ANNILLO, DONNA A (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:A
Last Name:ANNILLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 GARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2653
Mailing Address - Country:US
Mailing Address - Phone:201-836-0003
Mailing Address - Fax:201-836-0003
Practice Address - Street 1:933 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2653
Practice Address - Country:US
Practice Address - Phone:201-836-0003
Practice Address - Fax:201-836-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00171900213EP1101X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4826507Medicaid
NJ4826507Medicaid
NJ454163Medicare PIN