Provider Demographics
NPI:1194206441
Name:MADISON PHYSICIAN PRACTICE PC
Entity Type:Organization
Organization Name:MADISON PHYSICIAN PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-351-0911
Mailing Address - Street 1:983 PARK AVE STE 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0808
Mailing Address - Country:US
Mailing Address - Phone:212-427-8761
Mailing Address - Fax:
Practice Address - Street 1:983 PARK AVE # 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0808
Practice Address - Country:US
Practice Address - Phone:212-427-8761
Practice Address - Fax:212-427-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty