Provider Demographics
NPI:1184196537
Name:MADARASSY, CHARLENE MARY (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARY
Last Name:MADARASSY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:CHARLENE
Other - Middle Name:MARY
Other - Last Name:MADARASSY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:614 COOPER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-2906
Mailing Address - Country:US
Mailing Address - Phone:518-283-6500
Mailing Address - Fax:518-283-0524
Practice Address - Street 1:614 COOPER HILL RD
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-2906
Practice Address - Country:US
Practice Address - Phone:518-283-6500
Practice Address - Fax:518-283-0524
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274516-1163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent