MEDICARE: MADELEINE MYERS 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	363LF0000X	Family Nurse Practitioner	F332585-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	387618	OTHER	NY	RN LICENSE

General Provider Information

NPI Number	:	1891988853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE MYERS NP

Provider Business Mailing Address
First Line	:	2 COATES DR
Second Line	:
City	:	GOSHEN
State	:	NY
Zip	:	10924-6758
Country	:	US
Telephone Number	:	845-651-1400
Fax Number	:	845-651-1512

Provider Business Practice Location Address
First Line	:	1200 STATE ROUTE 208
Second Line	:	SUITE 13
City	:	MONROE
State	:	NY
Zip	:	10950-4648
Country	:	US
Telephone Number	:	845-783-6266
Fax Number	:	845-783-9570

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

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/16/2010

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