Healthcare Provider Details

I. General information

NPI: 1124126818
Provider Name (Legal Business Name): MICHAEL ANDREW MINARDO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W 19TH ST
NEW YORK NY
10011-4223
US

IV. Provider business mailing address

55 W 19TH ST
NEW YORK NY
10011-4223
US

V. Phone/Fax

Practice location:
  • Phone: 212-488-3400
  • Fax: 212-488-3401
Mailing address:
  • Phone: 212-488-3400
  • Fax: 212-488-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX44781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: