Provider Demographics
NPI:1710061973
Name:MEDINA, EMMA (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LOCKWOOD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4909
Mailing Address - Country:US
Mailing Address - Phone:914-632-1600
Mailing Address - Fax:914-576-4770
Practice Address - Street 1:140 LOCKWOOD AVE STE 310
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4909
Practice Address - Country:US
Practice Address - Phone:914-632-1600
Practice Address - Fax:914-576-4770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143497207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0367045OtherCIGNA
0046926OtherAETNA
NY0066930OtherGHI
NY00863727Medicaid
NYWS902OtherOXFORD
NY2C4799OtherHEALTHNET
NY2C4799OtherHEALTHNET
NYB10558Medicare UPIN