Provider Demographics
NPI:1730240706
Name:DONELSON, KAREN (PT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:DONELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DONELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:106 ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4104
Mailing Address - Country:US
Mailing Address - Phone:973-809-0186
Mailing Address - Fax:
Practice Address - Street 1:30 W 60TH ST
Practice Address - Street 2:# 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7902
Practice Address - Country:US
Practice Address - Phone:973-809-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01112600OtherPHYSCIAL THERAPIST
NYQO9V91Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
NJ086065Medicare ID - Type UnspecifiedPHYSICAL THERAPIST