Healthcare Provider Details

I. General information

NPI: 1154874139
Provider Name (Legal Business Name): MADELEINE BANULSKI ZIEGLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HATFIELD LN SUITE 101
GOSHEN NY
10924
US

IV. Provider business mailing address

30 HATFIELD LN SUITE 101
GOSHEN NY
10924-6766
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-2733
  • Fax:
Mailing address:
  • Phone: 845-294-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number100685
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number698775
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6525
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: