Provider Demographics
NPI:1932297629
Name:MADDEN, MICHAEL J (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MADDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NORTH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2217
Mailing Address - Country:US
Mailing Address - Phone:914-682-9440
Mailing Address - Fax:914-682-9441
Practice Address - Street 1:311 NORTH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2217
Practice Address - Country:US
Practice Address - Phone:914-682-9440
Practice Address - Fax:914-682-9441
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0037661213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00865903Medicaid
NYP369112OtherOXFORD HEALTH PLANS
NY436455OtherUNITED HEALTHCARE
NYP39781Medicare PIN
T51214Medicare UPIN
NY00865903Medicaid
NYA400022300Medicare PIN