Provider Demographics
NPI: | 1295827145 |
---|---|
Name: | MINOLA, GUISEPPE (M D) |
Entity Type: | Individual |
Prefix: | |
First Name: | GUISEPPE |
Middle Name: | |
Last Name: | MINOLA |
Suffix: | |
Gender: | M |
Credentials: | M D |
Other - Prefix: | |
Other - First Name: | JOSEPH |
Other - Middle Name: | |
Other - Last Name: | MINOLA |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | |
Mailing Address - Street 1: | 40 MONTGOMERY STREET |
Mailing Address - Street 2: | HENRY STREET SETTLEMENT COMMUNITY CONSULTATION CENTER |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10002 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-233-5032 |
Mailing Address - Fax: | 212-571-4132 |
Practice Address - Street 1: | 40 MONTGOMERY STREET |
Practice Address - Street 2: | HENRY STREET SETTLEMENT COMMUNITY CONSULTATION CENTER |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10002 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-233-5032 |
Practice Address - Fax: | 212-571-4132 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-29 |
Last Update Date: | 2009-03-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 149063 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 00149063 | Medicaid | |
NY | 00149063 | Medicaid |