Provider Demographics
NPI:1518994425
Name:MINERVINO, RALPH ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANTHONY
Last Name:MINERVINO
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:400 FORT HILL AVE
Mailing Address - Street 2:PODIATRY CLINIC #129
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1159
Mailing Address - Country:US
Mailing Address - Phone:585-393-8108
Mailing Address - Fax:585-393-8573
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:PODIATRY CLINIC #129
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-393-8108
Practice Address - Fax:585-393-8573
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002473-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist