Provider Demographics
NPI:1154654077
Name:WHITE PLAINS DERMATOLOGY ASSOC PC
Entity Type:Organization
Organization Name:WHITE PLAINS DERMATOLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-949-0477
Mailing Address - Street 1:170 MAPLE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4710
Mailing Address - Country:US
Mailing Address - Phone:914-949-0477
Mailing Address - Fax:914-949-0542
Practice Address - Street 1:170 MAPLE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4710
Practice Address - Country:US
Practice Address - Phone:914-949-0477
Practice Address - Fax:914-949-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty