Basic Information
| Provider Information | |||||||||
| NPI: | 1346253275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADMON | ||||||||
| FirstName: | LORI | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | DAVIS AVE AT E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811074 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | DAVIS AVE AT E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811074 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 228499 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | TIN | 01 | HORIZION | OTHER | 5C4280 | 01 | NY | HEALTH NET | OTHER | 7213822 | 01 | NY | AETNA - PPO | OTHER | TIN | 01 | MULTIPLAN | OTHER | 1141007 | 01 | NY | AETNA - HMO | OTHER | 686Y61 | 01 | NY | EMPIRE BC/BS | OTHER | P3640043 | 01 | NY | OXFORD HEALTH PLAN | OTHER | 3057246 | 01 | NY | CIGNA | OTHER | 2582863 | 01 | NY | UNITED HEALTHCARE | OTHER |