| Elizabeth Madison Nutrition, Pllc | |
|
13333 Brookville Boulevard Suite 229c Rosedale NY 11422 | |
| (855) 958-9958 | |
| (855) 947-3783 |
| Full Name | Elizabeth Madison Nutrition, Pllc |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 13333 Brookville Boulevard, Rosedale, New York |
| Authorized Official Name and Position | Elizabeth M Madison (CEO) |
| Authorized Official Contact | 8559589958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth Madison Nutrition, Pllc 22919 Merrick Blvd #226 Laurelton NY 11413-2108 Ph: (718) 276-6037 | Elizabeth Madison Nutrition, Pllc 13333 Brookville Boulevard Suite 229c Rosedale NY 11422 Ph: (855) 958-9958 |
| NPI Number | 1851785380 |
|---|---|
| Provider Enumeration Date | 03/23/2015 |
| Last Update Date | 10/16/2019 |
| Medicare PECOS PAC ID | 9133431430 |
|---|---|
| Medicare Enrollment ID | O20150629002573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851785380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 133V00000X | Dietitian, Registered | 00800548 (New York) | Primary |
| Provider Name | Elizabeth M Madison |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1417293218 PECOS PAC ID: 7416179460 Enrollment ID: I20141107000341 |
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