1740224377 NPI number — DR. DONNA A ANNILLO D.P.M.

Table of content: DR. DONNA A ANNILLO D.P.M. (NPI 1740224377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740224377 NPI number — DR. DONNA A ANNILLO D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANNILLO
Provider First Name:
DONNA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1740224377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 GARRISON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEANECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07666-2653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-836-0003
Provider Business Mailing Address Fax Number:
201-836-0003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
933 GARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-836-0003
Provider Business Practice Location Address Fax Number:
201-836-0003
Provider Enumeration Date:
06/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  25MD00171900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0000X , with the licence number: 25MD00171900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 25MD00171900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 25MD00171900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4826507 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".