Provider Demographics
NPI:1134532591
Name:ROGER S MADRIS, M.D., P.C.
Entity type:Organization
Organization Name:ROGER S MADRIS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MADRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-253-6504
Mailing Address - Street 1:10 RYE RIDGE PLZ
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2828
Mailing Address - Country:US
Mailing Address - Phone:914-253-6504
Mailing Address - Fax:914-253-6507
Practice Address - Street 1:10 RYE RIDGE PLZ
Practice Address - Street 2:SUITE 105
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2828
Practice Address - Country:US
Practice Address - Phone:914-253-6504
Practice Address - Fax:914-253-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00822564Medicaid
A99802Medicare UPIN