1134674732 NPI number — MS. MADELINE CATHERINE KIDD D.O.

Table of content: MS. MADELINE CATHERINE KIDD D.O. (NPI 1134674732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134674732 NPI number — MS. MADELINE CATHERINE KIDD D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIDD
Provider First Name:
MADELINE
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134674732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/20/2022
NPI Reactivation Date:
06/03/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 HANCOCK ST.
Provider Second Line Business Mailing Address:
APT 17
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-591-6097
Provider Business Mailing Address Fax Number:
617-591-6435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 HANCOCK ST.
Provider Second Line Business Practice Location Address:
APT 17
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-344-9288
Provider Business Practice Location Address Fax Number:
617-591-6435
Provider Enumeration Date:
08/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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