Healthcare Provider Details

I. General information

NPI: 1922280544
Provider Name (Legal Business Name): MADISON ENT & FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVENUE SUITE 11W
NEW YORK NY
10016
US

IV. Provider business mailing address

161 MADISON AVENUE SUITE 11W
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-213-3339
  • Fax: 212-213-3494
Mailing address:
  • Phone: 212-213-3339
  • Fax: 212-213-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY LYNN SILVERS
Title or Position: PRESIDENT
Credential: MD
Phone: 212-213-3339