Healthcare Provider Details

I. General information

NPI: 1255798096
Provider Name (Legal Business Name): MEDICAL GROUP OF MINEOLA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STATION PLZ N SUITE 310
MINEOLA NY
11501-3800
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 204
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2691
  • Fax: 516-663-8971
Mailing address:
  • Phone: 516-576-5842
  • Fax: 516-576-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON PINKHASOV
Title or Position: CO-PRESIDENT
Credential: MD
Phone: 516-663-2691