Provider Demographics
NPI:1407893647
Name:DONNELLEY, NAOMI STRACHAN (MD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:STRACHAN
Last Name:DONNELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PARK AVE
Mailing Address - Street 2:#1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-818-1743
Mailing Address - Fax:212-818-1783
Practice Address - Street 1:1075 PARK AVE
Practice Address - Street 2:#1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-818-1743
Practice Address - Fax:212-818-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215121207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112253Medicaid
I26485Medicare UPIN
IL036-112253Medicaid