Provider Demographics
NPI:1942872759
Name:STATLINE MEDICAL PC
Entity Type:Organization
Organization Name:STATLINE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MADORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-215-4748
Mailing Address - Street 1:3 SONOMA RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-5129
Mailing Address - Country:US
Mailing Address - Phone:914-215-4748
Mailing Address - Fax:
Practice Address - Street 1:3 SONOMA RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-5129
Practice Address - Country:US
Practice Address - Phone:914-215-4748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty