Provider Demographics
NPI:1992063820
Name:GLORIA B. DONAII
Entity type:Organization
Organization Name:GLORIA B. DONAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONAII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-576-7052
Mailing Address - Street 1:60 SEYMOUR LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1061
Mailing Address - Country:US
Mailing Address - Phone:631-576-7050
Mailing Address - Fax:
Practice Address - Street 1:60 SEYMOUR LN
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1061
Practice Address - Country:US
Practice Address - Phone:631-576-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267481-1313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility