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General NPI Number Information
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NPI Number | 1710990965
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Entity Type | Individual
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Provider Name | IRWIN MEDINA DDS
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 47 E 77TH ST STE 216
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City | NEW YORK
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State | NY
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Zip | 10075-1730
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Country | US
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Telephone | 212-689-7199
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SADORE LN APT 7X
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City | YONKERS
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State | NY
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Zip | 10710-4757
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Country | US
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Telephone | 914-393-5715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051836
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License Number State | NY
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