Provider Demographics
NPI:1326147315
Name:MADISON AVENUE PHYSICIANS, PC
Entity Type:Organization
Organization Name:MADISON AVENUE PHYSICIANS, PC
Other - Org Name:ESTELA OGISTE MD PHD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OGISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-348-6001
Mailing Address - Street 1:PO BOX 7821
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10116-7821
Mailing Address - Country:US
Mailing Address - Phone:212-348-6001
Mailing Address - Fax:212-348-6067
Practice Address - Street 1:1789 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4537
Practice Address - Country:US
Practice Address - Phone:212-348-6001
Practice Address - Fax:212-348-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213367207W00000X
NY242427208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH40131Medicare UPIN