Provider Demographics
NPI:1679728968
Name:MADISON AVENUE OPERATORY
Entity type:Organization
Organization Name:MADISON AVENUE OPERATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SILVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-213-3339
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:SUITE 11W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-213-3339
Mailing Address - Fax:212-213-3494
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:SUITE 11W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-213-3339
Practice Address - Fax:212-213-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202817261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical