Provider Demographics
NPI:1225142896
Name:MADNANI, DILIP (MD)
Entity Type:Individual
Prefix:
First Name:DILIP
Middle Name:
Last Name:MADNANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 2ND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4709
Mailing Address - Country:US
Mailing Address - Phone:212-661-3376
Mailing Address - Fax:212-661-3366
Practice Address - Street 1:800 2ND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4709
Practice Address - Country:US
Practice Address - Phone:212-661-3376
Practice Address - Fax:212-661-3366
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2006-0201207Y00000X
NY258278207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00659899OtherRAILROAD MEDICARE
NMP00379546OtherRAILROAD MEDICARE
NM4025971Medicaid
NM00NM001P04OtherBCBS
NMP00659899OtherRAILROAD MEDICARE
NM346633905Medicare PIN
NMNMB0003Medicare PIN