Provider Demographics
NPI:1003902156
Name:MENNIN, GERALD S (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:S
Last Name:MENNIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:45 LUDLOW ST
Mailing Address - Street 2:SUITE 618
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:914-969-6995
Mailing Address - Fax:914-969-2917
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 618
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-969-6995
Practice Address - Fax:914-969-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY82673207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY48Z791OtherEMPIRE BLUE CROSS BLUE SH
NY4096908OtherAETNA
NYOH4152OtherHEALTHNET
NYWS005OtherOXFORD HEALTH PLANS
NY23228POtherHIP HEALTH PLAN NY
NY00121706Medicaid
NY48Z791OtherEMPIRE BLUE CROSS BLUE SH
NYB10497Medicare UPIN