Organization
MADONNA'S WELL WOMAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MADONNA MARY HOLDER C.N.M (PRESIDENT)
(718) 977-0777
Entity
Organization
Contact information
Practice address
25412 MEMPHIS AVE, ROSEDALE, NY 11422-2545
(718) 977-0777
(718) 977-0778
Mailing address
25412 MEMPHIS AVE, ROSEDALE, NY 11422-2545
(718) 977-0777
(718) 977-0778
Taxonomy
Speciality
Code
Description
License number
State
261QF0050X
Non-Surgical Family Planning Clinic/Center
Primary
FOOOO88
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01859723
—
NY
Enumeration date
05/31/2007
Last updated
08/22/2020
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