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General NPI Number Information
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NPI Number | 1689403404
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Entity Type | Individual
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Provider Name | MADYSON LEANN ROSS PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 8900 VAN WYCK EXPY
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2832
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Country | US
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Telephone | 718-206-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 40 MEMORIAL HWY APT 14R
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-8327
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Country | US
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Telephone | 518-469-6703
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 032945
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License Number State | NY
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