Healthcare Provider Details

I. General information

NPI: 1174604508
Provider Name (Legal Business Name): ASSUMPTA A MADU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST 210TH STREET MONTEFIORE MEDICAL CENTER DEPARTMENT OF OPHTHALMOLOGY
BRONX NY
10467
US

IV. Provider business mailing address

111 EAST 210TH STREET MONTEFIORE MEDICAL CENTER
BRONX NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2020
  • Fax:
Mailing address:
  • Phone: 718-920-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number199355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: