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NPI Code Detail

MEDICARE: HENRY MADAMBA

MEDICARE:   HENRY  MADAMBA
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
1103TC1900XCounseling Psychologist37PC00096500NJ

General Provider Information

NPI Number : 1619344496
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY MADAMBA
Provider Business Mailing Address
First Line : 750 PASADENA DR
Second Line :
City : NORTHFIELD
State : NJ
Zip : 08225-1169
Country : US
Telephone Number : 609-287-0697
Fax Number :
Provider Business Practice Location Address
First Line : 222 NEW RD STE 405
Second Line :
City : LINWOOD
State : NJ
Zip : 08221-1283
Country : US
Telephone Number : 609-289-5354
Fax Number : 609-266-0459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2015
Last Update Date : 08/27/2015

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Directions to “ HENRY MADAMBA ” Practice Location

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