Provider Demographics
NPI:1477046522
Name:MADRY, MIRIAM A (OD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:A
Last Name:MADRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W 142ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1865
Mailing Address - Country:US
Mailing Address - Phone:212-439-9600
Mailing Address - Fax:646-410-0667
Practice Address - Street 1:147 W 142ND ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1865
Practice Address - Country:US
Practice Address - Phone:212-439-9600
Practice Address - Fax:646-410-0667
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008826152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation