Healthcare Provider Details

I. General information

NPI: 1023159761
Provider Name (Legal Business Name): MADISON SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE SUITE 705
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE SUITE 705
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-675-2997
  • Fax: 212-627-8389
Mailing address:
  • Phone: 212-675-2997
  • Fax: 212-627-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number199737-1
License Number StateNY

VIII. Authorized Official

Name: DR. LESTER GOTTESMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 212-675-2997