Healthcare Provider Details

I. General information

NPI: 1417889353
Provider Name (Legal Business Name): MADISON PETERSIL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY DEPARTMENT OF WOMEN'S HEALTH 8-300
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY DEPARTMENT OF WOMEN'S HEALTH 8-300
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8251
  • Fax: 718-963-8244
Mailing address:
  • Phone: 718-963-8251
  • Fax: 718-963-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number953496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: