MEDICARE: MICHAEL H MINOFF 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	207V00000X	Obstetrics & Gynecology Physician	25MA04419600	NJ

General Provider Information

NPI Number	:	1538130604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL H MINOFF M.D.

Provider Business Mailing Address
First Line	:	227 LAUREL RD
Second Line	:	STE 300
City	:	VOORHEES
State	:	NJ
Zip	:	08043-8303
Country	:	US
Telephone Number	:	856-669-6050
Fax Number	:	856-651-0794

Provider Business Practice Location Address
First Line	:	110 MARTER AVE
Second Line	:	STE 504
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3124
Country	:	US
Telephone Number	:	856-642-6580
Fax Number	:	856-273-8372

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/11/2012

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