MEDICARE: DR. ROBERT I MADISON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30873	NY

General Provider Information

NPI Number	:	1710181938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT I MADISON D.D.S.

Provider Business Mailing Address
First Line	:	2 W END AVE
Second Line	:	PROFESSIONAL SUITE
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4848
Country	:	US
Telephone Number	:	718-743-1339
Fax Number	:	718-332-4891

Provider Business Practice Location Address
First Line	:	2 W END AVE
Second Line	:	PROFESSIONAL SUITE
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4848
Country	:	US
Telephone Number	:	718-743-1339
Fax Number	:	718-332-4891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/08/2007

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