Provider Demographics
NPI:1265417018
Name:BOROUGH OF MADISON
Entity type:Organization
Organization Name:BOROUGH OF MADISON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH NURSE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:973-593-3079
Mailing Address - Street 1:28 WALNUT ST
Mailing Address - Street 2:MADISON HEALTH DEPARTMENT
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1638
Mailing Address - Country:US
Mailing Address - Phone:973-593-3079
Mailing Address - Fax:973-593-3072
Practice Address - Street 1:28 WALNUT ST
Practice Address - Street 2:MADISON HEALTH DEPARTMENT
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1638
Practice Address - Country:US
Practice Address - Phone:973-593-3079
Practice Address - Fax:973-593-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR50047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527831Medicare PIN