Provider Demographics
NPI:1962199380
Name:DONALDY, WEBSTER (MD)
Entity type:Individual
Prefix:
First Name:WEBSTER
Middle Name:
Last Name:DONALDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 WEST 141 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10030
Mailing Address - Country:US
Mailing Address - Phone:347-610-2965
Mailing Address - Fax:
Practice Address - Street 1:MLK 13-106 506 LENOX AVENUE DEPT OF MEDICINE
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-1406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-12-11
Deactivation Date:2023-11-22
Deactivation Code:
Reactivation Date:2023-12-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program