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General NPI Number Information
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NPI Number | 1649656018
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Entity Type | Organization
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Legal Business Name | MADISON SQUARE MEDICAL
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 51 E 25TH ST 4TH FLOOR, SUITE 4B
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City | NEW YORK
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State | NY
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Zip | 10010-2945
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Country | US
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Telephone | 212-533-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 51 E 25TH ST 4TH FLOOR, SUITE 4B
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City | NEW YORK
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State | NY
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Zip | 10010-2945
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Country | US
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Telephone | 212-533-2400
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | SHAWN KHODADADIAN
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Credential | M.D.
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Telephone | 212-533-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 236127-1
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License Number State | NY
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