Healthcare Provider Details

I. General information

NPI: 1295038024
Provider Name (Legal Business Name): ASHLEY MADSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 E MAIN ST STE 201
SOMERVILLE NJ
08876-2319
US

IV. Provider business mailing address

33 W END AVE APT 21A
NEW YORK NY
10023-7824
US

V. Phone/Fax

Practice location:
  • Phone: 908-680-0684
  • Fax:
Mailing address:
  • Phone: 631-258-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00835100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number014288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: