Provider Demographics
NPI:1588892350
Name:MADONNA SERVICE LTD
Entity type:Organization
Organization Name:MADONNA SERVICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-433-5018
Mailing Address - Street 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-747-4616
Mailing Address - Fax:516-747-4756
Practice Address - Street 1:375 N BROADWAY
Practice Address - Street 2:SUITE LL2
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2016
Practice Address - Country:US
Practice Address - Phone:516-433-5018
Practice Address - Fax:516-433-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health