Provider Demographics
NPI:1053415133
Name:DONADT, ROBERT BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:DONADT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7889
Mailing Address - Fax:631-454-4161
Practice Address - Street 1:6967 108TH STREET
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3846
Practice Address - Country:US
Practice Address - Phone:718-268-4938
Practice Address - Fax:718-268-2963
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1514821207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01151266Medicaid
NY01151266Medicaid
NYG400064192Medicare PIN