Provider Demographics
NPI:1629228010
Name:MINOR, JOHN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:MINOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5178
Mailing Address - Country:US
Mailing Address - Phone:315-798-8737
Mailing Address - Fax:315-732-1702
Practice Address - Street 1:1508 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5178
Practice Address - Country:US
Practice Address - Phone:315-798-8737
Practice Address - Fax:315-732-1702
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008368208100000X
VA0102202192208100000X
NJ25MB05670800208100000X
NY176034208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03207738Medicaid