Healthcare Provider Details

I. General information

NPI: 1184196537
Provider Name (Legal Business Name): CHARLENE MARY MADARASSY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLENE MARY MADARASSY REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 COOPER HILL RD
WYNANTSKILL NY
12198-2906
US

IV. Provider business mailing address

614 COOPER HILL RD
WYNANTSKILL NY
12198-2906
US

V. Phone/Fax

Practice location:
  • Phone: 518-283-6500
  • Fax: 518-283-0524
Mailing address:
  • Phone: 518-283-6500
  • Fax: 518-283-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number274516-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: