Madison Physician Practice PC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

MADISON PHYSICIAN PRACTICE PC

Practice address

983 Park Ave # 1D
New York, NY 10028-0808

Phone

(212) 427-8761

Fax

(212) 427-8762

NPI assigned

Aug 24, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angela Laza

Title

Billing Manager

Phone

(646) 351-0911

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Howard P Reynolds, MD

  • Anesthesiology Physician
  • New York, NY
  • NPI 1891870366
  Medicare reassignment Care Compare group NPD
• Gem Marian Manalo, MD

  • Anesthesiology Physician
  • Boston, MA
  • NPI 1932604121

  NY

  Medicare reassignment Care Compare group NPD
• Gerald Park, MD

  • Anesthesiology Physician
  • New York, NY
  • NPI 1386842540
  Medicare reassignment NPD
• Shawn Khodadadian, M.D.

  • Gastroenterology Physician
  • New York, NY
  • NPI 1952505018
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535068800000",
    "number": "1194206441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "983 PARK AVE STE 1D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100280808",
            "telephone_number": "212-427-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983 PARK AVE # 1D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100280808",
            "telephone_number": "212-427-8761",
            "fax_number": "212-427-8762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PHYSICIAN PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-24",
        "last_updated": "2018-08-24",
        "status": "A",
        "authorized_official_last_name": "LAZA",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "646-351-0911"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Optical Inc.
• Madison Pain Management, PC
• Madison Park Psychological Services
• Madison Pediatrics P.C.
• Madison Phcy and Surgical Supply Co
• Madison Plastic Surgery P.C
• Madison RX Pharmacy Inc.
• Madison Specialty Pharmacy, Inc.
• Madison Square Chiropractic and Acupuncture, PLLC
• Madison Square Comprehensive Medical Care, PLLC (Advanced Pathology Laboratories)

• Adult Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Adult Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.