=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811815954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON VICTORIA SPINA APN-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 KNICKERBOCKER RD
-----------------------------------------------------
City | CRESSKILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07626-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-527-7953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 263 RIVER RD
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07646-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-527-7953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15593700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------