Basic Information
| Provider Information | |||||||||
| NPI: | 1306079892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADISON AVENUE PHYSICIAN SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 WEST GILBERT STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120060 | ||||||||
| FaxNumber: | 7322120061 | ||||||||
| Practice Location | |||||||||
| Address1: | 1879 MADISON AVENUE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100352709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124234011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2009 | ||||||||
| LastUpdateDate: | 08/31/2009 | ||||||||
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| AuthorizedOfficialLastName: | CALABRO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7322120060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.