Provider Demographics
NPI:1851453708
Name:KESSELMAN, DONNA R (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:KESSELMAN
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 1:101 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0301
Mailing Address - Country:US
Mailing Address - Phone:212-988-1700
Mailing Address - Fax:212-988-2075
Practice Address - Street 1:101 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0301
Practice Address - Country:US
Practice Address - Phone:212-988-1700
Practice Address - Fax:212-988-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211493208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220166Medicaid
NYH41333Medicare UPIN
NYWEV121Medicare ID - Type Unspecified