Provider Demographics
NPI:1346230737
Name:VILLAGE OF MADISON
Entity Type:Organization
Organization Name:VILLAGE OF MADISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-724-6619
Mailing Address - Street 1:PO BOX 4066
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13504-4066
Mailing Address - Country:US
Mailing Address - Phone:315-724-6619
Mailing Address - Fax:315-797-2579
Practice Address - Street 1:7362 STATE ROUTE 20
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NY
Practice Address - Zip Code:13402-9530
Practice Address - Country:US
Practice Address - Phone:315-893-1894
Practice Address - Fax:315-893-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0757341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00239467OtherRAILROAD
NY02664006Medicaid
NYP00239467OtherRAILROAD