Provider Demographics
NPI:1194029900
Name:MAD PA SERVICES, INC
Entity Type:Organization
Organization Name:MAD PA SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALTO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:646-825-1040
Mailing Address - Street 1:60 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3008
Mailing Address - Country:US
Mailing Address - Phone:845-352-0301
Mailing Address - Fax:
Practice Address - Street 1:60 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3008
Practice Address - Country:US
Practice Address - Phone:845-352-0301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008674363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty