Healthcare Provider Details

I. General information

NPI: 1700824901
Provider Name (Legal Business Name): MICHAEL PATRICK MADDEN CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9A HERBERT DR
LATHAM NY
12110
US

IV. Provider business mailing address

# 7 RT 151
EAST GREENBUSH NY
12061
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-0687
  • Fax: 518-786-0687
Mailing address:
  • Phone: 518-786-0687
  • Fax: 518-786-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: