Ricardo Madiedo Sr., DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

X0096691 Issued in NY

Practice address

38-19 99TH St
1St FL
Corona, NY 11368-4842

Phone

(718) 651-6910

Fax

(718) 651-6911

NPI assigned

Sep 23, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740276831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38-19 99TH ST",
            "address_2": "1ST FL",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684842",
            "telephone_number": "718-651-6910",
            "fax_number": "718-651-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38-19 99TH ST",
            "address_2": "1ST FL",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684842",
            "telephone_number": "718-651-6910",
            "fax_number": "718-651-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADIEDO",
        "first_name": "RICARDO",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X0096691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01811930",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Corona, NY
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.