Provider Demographics
NPI:1942657218
Name:WEBBER, DONALD JR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:WEBBER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:452 CHURCH RD.
Mailing Address - City:LIVINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12541-0126
Mailing Address - Country:US
Mailing Address - Phone:518-943-0176
Mailing Address - Fax:
Practice Address - Street 1:713 UNION ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3001
Practice Address - Country:US
Practice Address - Phone:518-943-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P 426175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNYCPS-P426OtherNEW YORK PEER SPECIALIST CERTIFICATION BOARD