Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 5586460001 | NY |
Y | 225100000X | Physical Therapist | 009696-2 | NY |
N | 2251H1200X | Hand |
NPI | 1407800238 |
---|---|
Provider Name | Timothy John Madden |
First Address | New Hartford, NY 13413-1616 |
Second Address | New Hartford, NY 13413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5586460001 | DME SUPPLIER (01) | NY |