Provider Demographics
NPI:1053387100
Name:MADDEN, JEENA THERESA (MD)
Entity type:Individual
Prefix:
First Name:JEENA
Middle Name:THERESA
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:624 MCCLELLAN STREET
Mailing Address - Street 2:SUITE G05
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-347-5113
Mailing Address - Fax:518-347-5169
Practice Address - Street 1:624 MCCLELLAN STREET
Practice Address - Street 2:SUITE G05
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-347-5113
Practice Address - Fax:518-347-5169
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234436-1207Q00000X
NY234436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02755099Medicaid
NY02755099Medicaid
NY331833Medicare Oscar/Certification