Provider Demographics
NPI:1316372493
Name:MINKOWICZ, DVORA LEAH (MSED)
Entity Type:Individual
Prefix:
First Name:DVORA
Middle Name:LEAH
Last Name:MINKOWICZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4208
Mailing Address - Country:US
Mailing Address - Phone:718-467-1011
Mailing Address - Fax:
Practice Address - Street 1:1276 CARROLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4208
Practice Address - Country:US
Practice Address - Phone:718-467-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717571131171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator