Provider Demographics
NPI:1588610604
Name:HAMILTON MADISON HOUSE, INC
Entity Type:Organization
Organization Name:HAMILTON MADISON HOUSE, INC
Other - Org Name:HAMILTON-MADISON HOUSE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-740-1055
Mailing Address - Street 1:253 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7827
Mailing Address - Country:US
Mailing Address - Phone:212-720-4524
Mailing Address - Fax:212-732-9297
Practice Address - Street 1:253 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7827
Practice Address - Country:US
Practice Address - Phone:212-720-4524
Practice Address - Fax:212-732-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP6178100261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245143Medicaid
NYW01941Medicare ID - Type UnspecifiedOUT PATIENT MENTAL HEALTH