Provider Demographics
NPI:1134208796
Name:R A DONELLI
Entity type:Organization
Organization Name:R A DONELLI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-761-5500
Mailing Address - Street 1:80 EAST HARTSDALE AVE
Mailing Address - Street 2:R A DONELLI
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-761-5500
Mailing Address - Fax:914-761-6146
Practice Address - Street 1:80 EAST HARTSDALE AVE
Practice Address - Street 2:R A DONELLI
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-761-5500
Practice Address - Fax:914-761-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========Medicare UPIN