Healthcare Provider Details

I. General information

NPI: 1588892350
Provider Name (Legal Business Name): MADONNA SERVICE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N BROADWAY SUITE LL2
JERICHO NY
11753-2016
US

IV. Provider business mailing address

300 OLD COUNTRY RD SUITE 202
MINEOLA NY
11501-4198
US

V. Phone/Fax

Practice location:
  • Phone: 516-433-5018
  • Fax: 516-433-5084
Mailing address:
  • Phone: 516-747-4616
  • Fax: 516-747-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TERRY SPECTOR
Title or Position: COO
Credential:
Phone: 516-433-5018