Provider Demographics
NPI:1972634053
Name:DONNELLY, JAMES G (PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 1ST AVE
Mailing Address - Street 2:APT 21H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6482
Mailing Address - Country:US
Mailing Address - Phone:212-263-3416
Mailing Address - Fax:212-263-8284
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:NEW BELLEVUE ROOM 4E1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-263-3416
Practice Address - Fax:212-263-8284
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDONNJ1246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management