Provider Demographics
NPI:1538928213
Name:MADISON REALTIES, LLC
Entity type:Organization
Organization Name:MADISON REALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENDOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-283-2731
Mailing Address - Street 1:3452 E FOOTHILL BLVD STE 720
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6031
Mailing Address - Country:US
Mailing Address - Phone:626-796-8700
Mailing Address - Fax:626-568-1416
Practice Address - Street 1:8035 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3901
Practice Address - Country:US
Practice Address - Phone:480-686-8540
Practice Address - Fax:480-686-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy