Healthcare Provider Details

I. General information

NPI: 1811815954
Provider Name (Legal Business Name): MADISON VICTORIA SPINA APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 KNICKERBOCKER RD
CRESSKILL NJ
07626-1827
US

IV. Provider business mailing address

263 RIVER RD
NEW MILFORD NJ
07646-1721
US

V. Phone/Fax

Practice location:
  • Phone: 201-527-7953
  • Fax:
Mailing address:
  • Phone: 201-527-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15593700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: