Provider Demographics
NPI:1376757831
Name:LARRY H MINKOFF DPM
Entity Type:Organization
Organization Name:LARRY H MINKOFF DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MINKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-288-2866
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1210
Mailing Address - Country:US
Mailing Address - Phone:570-288-2866
Mailing Address - Fax:570-288-2866
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1210
Practice Address - Country:US
Practice Address - Phone:570-288-2866
Practice Address - Fax:570-288-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA130955OtherHIGHMARK BLUE SHIELD
PA130955OtherHIGHMARK BLUE SHIELD