Healthcare Provider Details

I. General information

NPI: 1356318992
Provider Name (Legal Business Name): THOMAS J MADEJSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OHIO ST
MEDINA NY
14103
US

IV. Provider business mailing address

100 OHIO ST
MEDINA NY
14103
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-3345
  • Fax: 585-798-3416
Mailing address:
  • Phone: 585-798-3345
  • Fax: 585-798-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number171989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: