Basic Information
| Provider Information | |||||||||
| NPI: | 1538617931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERMINGHAM | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 72 FARMEDGE RD | ||||||||
| Address2: | |||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117565202 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 72 FARMEDGE RD | ||||||||
| Address2: | |||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117565202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169217171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.