Healthcare Provider Details

I. General information

NPI: 1326147315
Provider Name (Legal Business Name): MADISON AVENUE PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 MADISON AVE
NEW YORK NY
10035-4537
US

IV. Provider business mailing address

PO BOX 7821
NEW YORK NY
10116-7821
US

V. Phone/Fax

Practice location:
  • Phone: 212-348-6001
  • Fax: 212-348-6067
Mailing address:
  • Phone: 212-348-6001
  • Fax: 212-348-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number213367
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number242427
License Number StateNY

VIII. Authorized Official

Name: DR. ESTELA V OGISTE
Title or Position: OWNER
Credential: MD
Phone: 212-348-6001