Provider Demographics
NPI:1730109687
Name:MADIS, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:MADIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-294-8888
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:30 HATFIELD LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6766
Practice Address - Country:US
Practice Address - Phone:845-291-7400
Practice Address - Fax:845-291-7049
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY149680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00782605Medicaid
NY02D051Medicare ID - Type Unspecified
NY00782605Medicaid