Provider Information for 1174173264
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MADISON LOCK CMHC
Sex: Female
NPI: 1174173264
Last Updated: 2019-09-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174173264 | ||||||||||||||
| Enumeration Date | 2019-09-19 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 285 VANDERBILT AVE STATEN ISLAND, NY 10304-2525 United States Phone: 718-981-4382 | Fax:718-981-2054 | ||||||||||||||
| Primary Practice Address | 285 VANDERBILT AVE STATEN ISLAND, NY 10304-2525 United States Phone: 718-981-4382 | Fax:718-981-2054 | ||||||||||||||
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