Provider Demographics
NPI:1407931371
Name:WINKLER, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:WINKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 EXPRESSWAY DR S
Mailing Address - Street 2:3
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2552
Mailing Address - Country:US
Mailing Address - Phone:631-758-0729
Mailing Address - Fax:631-758-5777
Practice Address - Street 1:476 EXPRESSWAY DR S
Practice Address - Street 2:3
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2552
Practice Address - Country:US
Practice Address - Phone:631-758-0729
Practice Address - Fax:631-758-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407931371OtherNPI
NY19A241Medicare ID - Type Unspecified
NYB10716Medicare UPIN