Healthcare Provider Details

I. General information

NPI: 1639143779
Provider Name (Legal Business Name): DR. LINDA ADDONIZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

10 COURTMEL RD
MOUNT KISCO NY
10549-3903
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7297
  • Fax: 212-544-1974
Mailing address:
  • Phone: 914-666-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number144944
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: