Provider Demographics
NPI:1093842189
Name:DAGLI, MADHU S (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:S
Last Name:DAGLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 N BROADWAY STE 108
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1315
Mailing Address - Country:US
Mailing Address - Phone:914-476-1322
Mailing Address - Fax:914-476-1346
Practice Address - Street 1:944 N BROADWAY
Practice Address - Street 2:STE 108
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1315
Practice Address - Country:US
Practice Address - Phone:914-476-1322
Practice Address - Fax:914-476-1346
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
971751OtherEMPIRE BLUE CROSS AND BLUE SHIELD
NY00437747Medicaid
NY971751OtherEMPIRE BLUE CROSS AND BLUE SHIELD
NY971751OtherEMPIRE BLUE CROSS AND BLUE SHIELD
NY35A021Medicare PIN