Provider Demographics
NPI:1730187147
Name:KIRELL, DONNA S (DPM)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:S
Last Name:KIRELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HARDWICK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4550
Mailing Address - Country:US
Mailing Address - Phone:631-673-0761
Mailing Address - Fax:
Practice Address - Street 1:16053 86 STREET
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-9999
Practice Address - Country:US
Practice Address - Phone:718-848-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003755213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845083Medicaid
NYT32056Medicare UPIN
NY66192Medicare ID - Type UnspecifiedQUEENS -GHI MEDICARE
NY00845083Medicaid
NYP38692Medicare ID - Type UnspecifiedBLUE CROSS