Provider Demographics
NPI:1770560658
Name:MADIWALE, NALINI A (MD)
Entity type:Individual
Prefix:DR
First Name:NALINI
Middle Name:A
Last Name:MADIWALE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2500 POND VW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:S SCHODACK
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9750
Mailing Address - Country:US
Mailing Address - Phone:518-477-2391
Mailing Address - Fax:518-477-2393
Practice Address - Street 1:3 ATRIUM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1417
Practice Address - Country:US
Practice Address - Phone:518-438-5273
Practice Address - Fax:518-438-5398
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY198496207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01665278Medicaid
NY01665278Medicaid
J400006187Medicare PIN
NYBB8080Medicare ID - Type Unspecified