Basic Information
| Provider Information | |||||||||
| NPI: | 1174604508 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MADU | ||||||||
| FirstName: | ASSUMPTA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 EAST 210TH STREET | ||||||||
| Address2: | MONTEFIORE MEDICAL CENTER | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189202020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 EAST 210TH STREET | ||||||||
| Address2: | MONTEFIORE MEDICAL CENTER DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189202020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 199355 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 01918845 | 05 | NY | MEDICAID |