Provider Demographics
NPI:1346253275
Name:MADMON, LORI (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MADMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DAVIS AVE AT E POST RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4615
Mailing Address - Country:US
Mailing Address - Phone:914-681-1074
Mailing Address - Fax:
Practice Address - Street 1:DAVIS AVE AT E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4615
Practice Address - Country:US
Practice Address - Phone:914-681-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TINOtherHORIZION
NY5C4280OtherHEALTH NET
NY7213822OtherAETNA - PPO
TINOtherMULTIPLAN
NY1141007OtherAETNA - HMO
NY686Y61OtherEMPIRE BC/BS
NYP3640043OtherOXFORD HEALTH PLAN
NY3057246OtherCIGNA
NY2582863OtherUNITED HEALTHCARE
NY686Y61Medicare PIN