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1619981172 NPI number — REBECCA EDITH PELLETT MADAN MD

NPI Number: 1619981172
Health Care Provider/Practitioner: REBECCA EDITH PELLETT MADAN MD

Information about “1619981172” NPI (REBECCA EDITH PELLETT MADAN MD) exists in 1619981172 in HTML format HTML  |  1619981172 in plain Text format TXT  |  1619981172 in PDF (Portable Document Format) PDF  |  1619981172 in an XML format XML  formats.

NPI Number : 1619981172 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619981172",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MADAN",
    "FirstName": "REBECCA",
    "MiddleName": "EDITH PELLETT",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PELLETT",
    "OtherFirstName": "REBECCA",
    "OtherMiddleName": "EDITH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "550 1ST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW YORK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10016-6402",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "646-501-2469",
    "MailingAddressFaxNumber": "212-263-7806",
    "FirstLinePracticeLocationAddress": "550 1ST AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10016-6402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-501-2469",
    "PracticeLocationAddressFaxNumber": "212-263-7806",
    "EnumerationDate": "07/28/2006",
    "LastUpdateDate": "05/29/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "227143",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2080P0208X",
          "TaxonomyName": "Pediatric Infectious Diseases Physician",
          "LicenseNumber": "227143",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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