Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 039756 | NY |
Y | 1223D0001X | Dental Public Health | 22DI02148700 | NJ |
NPI | 1336400852 |
---|---|
Provider Name | Dr. Maria D Madonna |
First Address | Paterson, NJ 07505-1115 |
Second Address | Paterson, NJ 07505-1115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2012 |