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General NPI Number Information
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NPI Number | 1619981172
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Entity Type | Individual
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Provider Name | REBECCA EDITH PELLETT MADAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 550 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 646-501-2469
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Fax | 212-263-7806
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Provider Business Mailing Address
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Address Line | 550 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 646-501-2469
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Fax | 212-263-7806
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 227143
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 227143
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License Number State | NY
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