Provider Demographics
NPI:1548328149
Name:DONATELLO, ANDREW JAMES (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:DONATELLO
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-0062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 NORTHWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-0062
Practice Address - Country:US
Practice Address - Phone:518-523-3357
Practice Address - Fax:518-523-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000571-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer