MEDICARE: MR. JOSEPH PATRICK MADELONE CRNA NP

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	363LA2100X	Acute Care Nurse Practitioner	431121	NY
2	367500000X	Certified Registered Nurse Anesthetist	603240	NY

General Provider Information

NPI Number	:	1538413646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH PATRICK MADELONE CRNA NP

Provider Business Mailing Address
First Line	:	202 CLEVELAND BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1104
Country	:	US
Telephone Number	:	518-723-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 CLEVELAND BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1104
Country	:	US
Telephone Number	:	518-723-0418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	08/27/2020

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