Provider Demographics
NPI:1255320073
Name:WINICK, DENISE L (PAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:WINICK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1155 PARK AVE
Mailing Address - Street 2:STE 316
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1209
Mailing Address - Country:US
Mailing Address - Phone:212-360-6500
Mailing Address - Fax:212-360-6535
Practice Address - Street 1:1155 PARK AVE
Practice Address - Street 2:STE 316
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1209
Practice Address - Country:US
Practice Address - Phone:212-360-6500
Practice Address - Fax:212-360-6535
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291602900Medicaid