Healthcare Provider Details

I. General information

NPI: 1467159780
Provider Name (Legal Business Name): MADELINE ANN FERRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MIDDLE SETTLEMENT RD STE 102
NEW HARTFORD NY
13413-5332
US

IV. Provider business mailing address

7 CRICKET LN
FAYETTEVILLE NY
13066-1604
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-4496
  • Fax: 315-735-7066
Mailing address:
  • Phone: 315-857-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: