Provider Demographics
NPI:1194832295
Name:VINCENT V MADONIA MD PC
Entity type:Organization
Organization Name:VINCENT V MADONIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MADONIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-741-6222
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5814
Mailing Address - Country:US
Mailing Address - Phone:516-741-6222
Mailing Address - Fax:516-741-6241
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5814
Practice Address - Country:US
Practice Address - Phone:516-741-6222
Practice Address - Fax:516-741-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071433207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00297030Medicaid
NY00297030Medicaid
NY493331Medicare PIN