Provider Demographics
NPI:1972716652
Name:LANIP, MADELON AGUILERA
Entity type:Individual
Prefix:
First Name:MADELON
Middle Name:AGUILERA
Last Name:LANIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 AXTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6110
Mailing Address - Country:US
Mailing Address - Phone:908-731-2048
Mailing Address - Fax:
Practice Address - Street 1:139 FULTON ST RM 700
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2533
Practice Address - Country:US
Practice Address - Phone:212-406-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist