Provider Demographics
NPI:1821296914
Name:MACKUSE, DONNA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:MACKUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SHORE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2100
Mailing Address - Country:US
Mailing Address - Phone:609-601-7820
Mailing Address - Fax:609-601-7822
Practice Address - Street 1:2000 SHORE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2100
Practice Address - Country:US
Practice Address - Phone:609-601-7820
Practice Address - Fax:609-601-7822
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB057531002084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF27276OtherUPIN
NJ5140803Medicaid
NJ722797Medicare UPIN