Provider Demographics
NPI:1831119171
Name:DONNON, HENRY P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:P
Last Name:DONNON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TWIN HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046
Mailing Address - Country:US
Mailing Address - Phone:609-877-5088
Mailing Address - Fax:609-877-2177
Practice Address - Street 1:4 TWIN HILL DRIVE
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046
Practice Address - Country:US
Practice Address - Phone:609-877-5088
Practice Address - Fax:609-877-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02237900208D00000X
PAMD010442E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1072464OtherHORIZON MERCY
222005560OtherTAX ID
89521OtherAMERIGROUP ID
NJD02644900OtherNJCDS
1094758OtherCIGNA PLAN CODE 030
222005560OtherHORIZON BLUE CROSS
47133OtherAETNA USHC
NJ4880609Medicaid
0078871002OtherAMERIHEALTH
243010895601OtherSTATE ID
2137OtherAETNA USHC
2137OtherAETNA USHC
222005560OtherHORIZON BLUE CROSS
96353Medicare ID - Type Unspecified