Healthcare Provider Details

I. General information

NPI: 1205139482
Provider Name (Legal Business Name): MADISON MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MADISON AVE RM 2305
NEW YORK NY
10017-5413
US

IV. Provider business mailing address

315 MADISON AVE RM 2305
NEW YORK NY
10017-5413
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-2127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAYANK SHUKLA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 516-395-2127