Provider Demographics
NPI:1063400307
Name:BARRESE, DONNA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:BARRESE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:BARRESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 6566
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-0566
Mailing Address - Country:US
Mailing Address - Phone:609-512-1126
Mailing Address - Fax:609-512-1639
Practice Address - Street 1:2633 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1086
Practice Address - Country:US
Practice Address - Phone:609-512-1126
Practice Address - Fax:609-512-1639
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00209300213E00000X
NJMD002093213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5539706Medicaid
0774260002Medicare NSC
NJU42427Medicare UPIN
NJ5539706Medicaid
NJ0774260001Medicare NSC
NJ747336N4HMedicare PIN