Individual
MISS MADISON ALEXANDRIA KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1275 YORK AVE, NEW YORK, NY 10065-6007
(212) 639-8684
Mailing address
1275 YORK AVE, NEW YORK, NY 10065-6007
(212) 639-8684
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
016745
NY
Other
Enumeration date
07/22/2013
Last updated
05/13/2014
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