Provider Demographics
NPI:1053382192
Name:DONALDSON, ROBERT D (NP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2924 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-7853
Mailing Address - Country:US
Mailing Address - Phone:845-338-0101
Mailing Address - Fax:845-338-1411
Practice Address - Street 1:967 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1301
Practice Address - Country:US
Practice Address - Phone:914-964-4301
Practice Address - Fax:914-964-4802
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF330824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01903171Medicaid
NY97V381Medicare ID - Type Unspecified
NY01903171Medicaid