Healthcare Provider Details

I. General information

NPI: 1093842189
Provider Name (Legal Business Name): MADHU S DAGLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 N BROADWAY STE 108
YONKERS NY
10701-1315
US

IV. Provider business mailing address

944 N BROADWAY STE 108
YONKERS NY
10701-1315
US

V. Phone/Fax

Practice location:
  • Phone: 914-476-1322
  • Fax: 914-476-1346
Mailing address:
  • Phone: 914-476-1322
  • Fax: 914-476-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number139897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: