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NPI Code Detail

MEDICARE: MRS. MADISON PETERSIL RN

MEDICARE: MRS. MADISON PETERSIL RN
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
1163WW0101XAmbulatory Women's Health Care Registered Nurse953496NY

General Provider Information

NPI Number : 1417889353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MADISON PETERSIL RN
Provider Business Mailing Address
First Line : 760 BROADWAY
Second Line : DEPARTMENT OF WOMEN'S HEALTH 8-300
City : BROOKLYN
State : NY
Zip : 11206-5317
Country : US
Telephone Number : 718-963-8251
Fax Number : 718-963-8244
Provider Business Practice Location Address
First Line : 760 BROADWAY
Second Line : DEPARTMENT OF WOMEN'S HEALTH 8-300
City : BROOKLYN
State : NY
Zip : 11206-5317
Country : US
Telephone Number : 718-963-8251
Fax Number : 718-963-8244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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