Provider Demographics
NPI:1942366547
Name:MADFES, DIANE C (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:MADFES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5314
Mailing Address - Country:US
Mailing Address - Phone:203-862-9407
Mailing Address - Fax:
Practice Address - Street 1:1 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4957
Practice Address - Country:US
Practice Address - Phone:212-249-8118
Practice Address - Fax:212-249-8884
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198602174400000X
CT039343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist