Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack L. Donaldson

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1346000379

Jack L. Donaldson is a Physician Assistant in Camillus, New York. Qualified in 2025, 1 year ago. Practices with St Josephs Medical PC, a 385-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
1
Licensed in
NY
In the registry since
2024

Practice location Address checks out

4997 Stagecoach Rd
Camillus, NY 13031-9774
Phone: (315) 744-0861
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X (NY)

Record details

NPI number1346000379
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 19, 2024
Last updated in NPPESMarch 19, 2024
Certification dateMarch 19, 2024
Mailing address4997 Stagecoach Rd, Camillus, NY 13031-9774

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice St Josephs Medical Pc — 385 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Camillus