Provider Demographics
NPI:1255425575
Name:DONATH, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DONATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-569-6966
Mailing Address - Fax:516-569-4026
Practice Address - Street 1:360 CENTRAL AVENUE
Practice Address - Street 2:SUITE 113
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559
Practice Address - Country:US
Practice Address - Phone:516-569-6966
Practice Address - Fax:516-569-4026
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141514207RP1001X
NY141514-0207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00701675Medicaid
NY00701675Medicaid
NYW11141Medicare PIN