Provider Demographics
NPI:1750622478
Name:DONALDSON, ROBERTO
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROCKAWAY PKWY
Mailing Address - Street 2:APT B42
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3100
Mailing Address - Country:US
Mailing Address - Phone:718-840-7925
Mailing Address - Fax:718-639-7684
Practice Address - Street 1:3524 83RD ST
Practice Address - Street 2:QUEENS COMMUNITY LIVING PROGRAM (3RD FLOOR)
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5229
Practice Address - Country:US
Practice Address - Phone:718-639-0700
Practice Address - Fax:718-639-7684
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor