Healthcare Provider Details

I. General information

NPI: 1073717484
Provider Name (Legal Business Name): MADELINE ANNE NAEGLE APRN-BC, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E 95TH ST 4F
NEW YORK NY
10128-0710
US

IV. Provider business mailing address

19 E 95TH ST
NEW YORK NY
10128-0710
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-9517
  • Fax: 212-995-4679
Mailing address:
  • Phone: 212-876-9517
  • Fax: 212-995-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number175701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: