Provider Demographics
NPI:1760756142
Name:MADDEN, MEGAN (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GUSTAVE LEVY PLACE
Mailing Address - Street 2:BOX 1497
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-7803
Mailing Address - Fax:212-860-3316
Practice Address - Street 1:1428 MADISON AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:212-241-7803
Practice Address - Fax:212-241-9467
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007335-1133V00000X
NY07335-1133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic