1053595496 NPI number — RICHARD S. DONELA

Table of content: (NPI 1053595496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053595496 NPI number — RICHARD S. DONELA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD S. DONELA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRI-STATE PODIATRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053595496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-442-8448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ADIRONDACK MEDICAL CENTER
Provider Second Line Business Practice Location Address:
29 CHURCH ST.
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-8345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DONELA
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
518-523-8345

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  2533 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)