Provider Demographics
NPI:1083994289
Name:MADAN, SHIVANK A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVANK
Middle Name:A
Last Name:MADAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHIVANK
Other - Middle Name:
Other - Last Name:MADAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3224 GRAND CONCOURSE
Mailing Address - Street 2:APT # C2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1008
Mailing Address - Country:US
Mailing Address - Phone:281-216-5926
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:MEDICAL ARTS PAVILLION- 7TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine