Healthcare Provider Details

I. General information

NPI: 1144480831
Provider Name (Legal Business Name): BEVERLY WINIKOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E 26TH ST 801
NEW YORK NY
10010-1505
US

IV. Provider business mailing address

15 E 26TH ST 801
NEW YORK NY
10010-1505
US

V. Phone/Fax

Practice location:
  • Phone: 212-448-1230
  • Fax: 212-448-1260
Mailing address:
  • Phone: 212-448-1230
  • Fax: 212-448-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number121282
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: