Provider Demographics
NPI:1679757017
Name:MADONIA, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MADONIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5801
Mailing Address - Country:US
Mailing Address - Phone:516-741-6222
Mailing Address - Fax:516-741-6241
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5801
Practice Address - Country:US
Practice Address - Phone:516-741-6222
Practice Address - Fax:516-741-6241
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00297030Medicaid
NY493331Medicare PIN
NYB15421Medicare UPIN