# MADONNA PHYSICIANS SERVICES PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Madonna Perinatal Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073606992
- **Authorized official:** TERRY SPECTOR (ADMINISTRATOR)
- **Authorized official phone:** (516) 633-5018

## Contact information

- **Practice address:** 300 OLD COUNTRY RD, MINEOLA, NY 11501
- **Practice address phone:** (516) 747-4616
- **Practice address fax:** (516) 747-4756
- **Mailing address:** 375 N BORADWAY, SUITE LL2, JERICHO, NY 11753
- **Mailing address phone:** (516) 433-5018
- **Mailing address fax:** (516) 433-5084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | 135376 | NY | — |
| 207VM0101X | Maternal & Fetal Medicine Physician | 217664 | NY | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 08/22/2020