Provider Demographics
NPI:1992578801
Name:WASZAK, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WASZAK
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 1:140 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4726
Mailing Address - Country:US
Mailing Address - Phone:505-506-8531
Mailing Address - Fax:
Practice Address - Street 1:140 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4726
Practice Address - Country:US
Practice Address - Phone:505-506-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist