Healthcare Provider Details

I. General information

NPI: 1386907814
Provider Name (Legal Business Name): MS. ANA C MADEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

29 ACACIA TER
NEW ROCHELLE NY
10805-3916
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-0962
  • Fax:
Mailing address:
  • Phone: 914-715-9664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number758953
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: