MEDICARE: DR. LAWRENCE MINARIK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207U00000X	Nuclear Medicine Physician	189227	NY

General Provider Information

NPI Number	:	1396843082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE MINARIK M.D.

Provider Business Mailing Address
First Line	:	530 W 236TH ST
Second Line	:	APT 1M
City	:	BRONX
State	:	NY
Zip	:	10463-1748
Country	:	US
Telephone Number	:	203-300-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 W 236TH ST
Second Line	:	APT 1M
City	:	BRONX
State	:	NY
Zip	:	10463-1748
Country	:	US
Telephone Number	:	203-300-7985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/07/2008

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