Healthcare Provider Details

I. General information

NPI: 1215063243
Provider Name (Legal Business Name): MADISON SURGICAL OBS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST # 9A
NEW YORK NY
10019-1104
US

IV. Provider business mailing address

425 W 59TH ST # 9A
NEW YORK NY
10019-1104
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-8417
  • Fax:
Mailing address:
  • Phone: 212-523-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL BERNSTEIN
Title or Position: DIRECTOR
Credential: MD
Phone: 212-523-8417