Healthcare Provider Details

I. General information

NPI: 1154957116
Provider Name (Legal Business Name): ERIN MADDEN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 THAYER RD
WEST POINT NY
10996-1700
US

IV. Provider business mailing address

3 COL CONKLIN DR
STONY POINT NY
10980-3640
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-2393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number003689-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: