Provider Demographics
NPI:1063576312
Name:MADISON IRVING PEDIATRICS, PC
Entity type:Organization
Organization Name:MADISON IRVING PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-898-2643
Mailing Address - Street 1:6711 TOWPATH RD STE 235
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9509
Mailing Address - Country:US
Mailing Address - Phone:315-471-2646
Mailing Address - Fax:315-471-1762
Practice Address - Street 1:6711 TOWPATH RD STE 235
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9509
Practice Address - Country:US
Practice Address - Phone:315-471-2646
Practice Address - Fax:315-471-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty