Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 003689-1 | NY |
NPI | 1154957116 |
---|---|
Provider Name | Erin Madden |
First Address | Stony Point, NY 10980-3640 |
Second Address | West Point, NY 10996-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 20/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26367 | HEALTHCARE PROVIDER (01) |