Basic Information
| Provider Information | |||||||||
| NPI: | 1457977969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADLEN | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 E AMES CT | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118032317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164145865 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 GARDEN CITY PLZ STE 100 | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115303337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164146900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2020 | ||||||||
| LastUpdateDate: | 06/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 025075 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.