Provider Demographics
NPI:1912912320
Name:KENNETH MADOFF,D.D.S.,P.C.
Entity Type:Organization
Organization Name:KENNETH MADOFF,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:NMI
Authorized Official - Last Name:MADOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-561-2494
Mailing Address - Street 1:8 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1420
Mailing Address - Country:US
Mailing Address - Phone:845-561-7575
Mailing Address - Fax:
Practice Address - Street 1:275 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3143
Practice Address - Country:US
Practice Address - Phone:845-561-2494
Practice Address - Fax:845-561-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0249951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty