Provider Demographics
NPI:1750362679
Name:FANELLI, DONNA JC (DNP)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JC
Last Name:FANELLI
Suffix:
Gender:F
Credentials:DNP
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Mailing Address - Street 1:ADVANTAGECARE PHYSICIANS, PC
Mailing Address - Street 2:55 WATER STREET 2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:120 PARK AVE
Practice Address - Street 2:LOWER LEVEL C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5577
Practice Address - Country:US
Practice Address - Phone:646-324-9461
Practice Address - Fax:646-324-1020
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2019-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NN06605500363LA2100X, 363LA2200X
NYF430118-1363LA2100X
NYF303208-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3598174OtherOXFORD
NJ2K9125OtherHEALTH NET
NJ286989OtherAMERIGROUP
NJ0067199Medicaid
NJ123OtherCIGNA
NJ2517320OtherUNITED HEALTHCARE
NJ286989OtherAMERIGROUP
NJ0067199Medicaid
NJ0067199Medicaid