Provider Demographics
NPI:1033319066
Name:MADDALENA, GREGORY E (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:MADDALENA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:845-838-7020
Mailing Address - Fax:845-838-6105
Practice Address - Street 1:6 HENRY ST
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3058
Practice Address - Country:US
Practice Address - Phone:845-831-0400
Practice Address - Fax:845-831-0793
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052146-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03350727Medicaid