Provider Demographics
NPI:1235907296
Name:DONOHUE RE, MARY E (EDMS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:DONOHUE RE
Suffix:
Gender:F
Credentials:EDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3449
Mailing Address - Country:US
Mailing Address - Phone:516-770-3969
Mailing Address - Fax:
Practice Address - Street 1:FAMILY OF KIDZ
Practice Address - Street 2:1400 OLD COUNTRY RD STE#C103N
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-806-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY746227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist