MEDICARE: MADISON MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS1201X	Sleep Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1205139482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON MEDICAL PC

Provider Business Mailing Address
First Line	:	315 MADISON AVE RM 2305
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 MADISON AVE RM 2305
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5413
Country	:	US
Telephone Number	:	516-395-2127
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MAYANK SHUKLA
Credential	:	MD
Telephone Number	:	516-395-2127

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	12/10/2010

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