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General NPI Number Information
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NPI Number | 1003627217
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Entity Type | Individual
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Provider Name | MADISON MIURA CGC
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 94 OLD SHORT HILLS RD STE 402
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5672
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Country | US
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Telephone | 973-322-8546
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 PATERSON PLANK RD APT 3309
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-1884
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Country | US
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Telephone | 808-781-7874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 25MJ00082600
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License Number State | NJ
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