Healthcare Provider Details

I. General information

NPI: 1508869884
Provider Name (Legal Business Name): GUY L MINTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

287 NORTHERN BLVD STE 211
GREAT NECK NY
11021-4717
US

IV. Provider business mailing address

287 NORTHERN BLVD STE 211
GREAT NECK NY
11021-4717
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-3401
  • Fax: 516-466-6929
Mailing address:
  • Phone: 516-482-3401
  • Fax: 516-466-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number162793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: