Provider Demographics
NPI:1154750610
Name:BARONE, MADELIENE ROSE (LPN)
Entity type:Individual
Prefix:
First Name:MADELIENE
Middle Name:ROSE
Last Name:BARONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1530
Mailing Address - Country:US
Mailing Address - Phone:631-772-8665
Mailing Address - Fax:
Practice Address - Street 1:392 PATTON AVE
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1530
Practice Address - Country:US
Practice Address - Phone:631-772-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240383-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse