=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942382213
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADHU H PADI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 03/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 BROADWAY STE 302A
-----------------------------------------------------
City | MENANDS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12204-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-433-1936
-----------------------------------------------------
Fax | 518-433-1937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 BROADWAY STE 302A
-----------------------------------------------------
City | MENANDS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12204-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-433-1936
-----------------------------------------------------
Fax | 518-433-1937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 172181
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------