Provider Demographics
NPI:1972520633
Name:THE CENTER FOR MEDICAL HEALING ON MADISON
Entity Type:Organization
Organization Name:THE CENTER FOR MEDICAL HEALING ON MADISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DA SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-485-0001
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10156-0726
Mailing Address - Country:US
Mailing Address - Phone:888-485-0001
Mailing Address - Fax:888-485-0001
Practice Address - Street 1:206 BERGEN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3324
Practice Address - Country:US
Practice Address - Phone:888-485-0001
Practice Address - Fax:888-485-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209768-12081P2900X
NJMB 729642081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6R1022Medicare ID - Type UnspecifiedID
NJ055088Medicare ID - Type UnspecifiedID
NYH27997Medicare UPIN