Healthcare Provider Details

I. General information

NPI: 1215858782
Provider Name (Legal Business Name): EDWARD MADDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JERICHO TPKE STE 203
NEW HYDE PARK NY
11040-4601
US

IV. Provider business mailing address

1300 JERICHO TPKE STE 203
NEW HYDE PARK NY
11040-4601
US

V. Phone/Fax

Practice location:
  • Phone: 203-883-9211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018169
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: