Provider Demographics
NPI:1033393301
Name:MADERIC, SYLVIA
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:
Last Name:MADERIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1434
Mailing Address - Country:US
Mailing Address - Phone:917-534-1370
Mailing Address - Fax:
Practice Address - Street 1:144 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1434
Practice Address - Country:US
Practice Address - Phone:917-534-1370
Practice Address - Fax:917-534-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist