Basic Information
| Provider Information | |||||||||
| NPI: | 1346401320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAUBRUN | ||||||||
| FirstName: | DONNIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 279 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100097813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124778500 | ||||||||
| FaxNumber: | 2128660559 | ||||||||
| Practice Location | |||||||||
| Address1: | 279 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100097813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188366600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2008 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 927533 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 263106 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.