Provider Demographics
NPI:1134364102
Name:DONATO A COLAVITA, MD PA
Entity type:Organization
Organization Name:DONATO A COLAVITA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:COLAVITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-344-6897
Mailing Address - Street 1:253 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2142
Mailing Address - Country:US
Mailing Address - Phone:973-344-6897
Mailing Address - Fax:973-344-3854
Practice Address - Street 1:253 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2142
Practice Address - Country:US
Practice Address - Phone:973-344-6897
Practice Address - Fax:973-344-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40963208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2058804Medicaid
NJC55775Medicare UPIN