1568568798 NPI number — DR. PATRICK LOUIS MADDALENA D.C.

Table of content: JASMIN ACEVEDO-STEPHENS (NPI 1174243984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568568798 NPI number — DR. PATRICK LOUIS MADDALENA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDALENA
Provider First Name:
PATRICK
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568568798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
189 JAMESTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14072-3210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-730-5737
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1645 HERTEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14216-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-446-9446
Provider Business Practice Location Address Fax Number:
716-446-9140
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X011200 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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