Healthcare Provider Details

I. General information

NPI: 1891606216
Provider Name (Legal Business Name): MS. MADISON KATE MEDWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 GODWIN TER
BRONX NY
10463-5346
US

IV. Provider business mailing address

94 HOMESTEAD AVE
AMITYVILLE NY
11701-3105
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-9645
  • Fax:
Mailing address:
  • Phone: 516-413-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036846-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: