Provider Demographics
NPI:1811975790
Name:MEHALESKO, DONNA CATHERINE (RPA-C)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:CATHERINE
Last Name:MEHALESKO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:128 MARY ALICE CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7145
Mailing Address - Country:US
Mailing Address - Phone:908-289-3387
Mailing Address - Fax:
Practice Address - Street 1:41 CLARKSON AVE
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1978
Practice Address - Country:US
Practice Address - Phone:718-245-4600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003968-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY864512Medicaid