Provider Demographics
NPI:1801838701
Name:VINOKUR, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VINOKUR
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 1:937 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2564
Mailing Address - Country:US
Mailing Address - Phone:631-369-0777
Mailing Address - Fax:631-369-0976
Practice Address - Street 1:937 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2564
Practice Address - Country:US
Practice Address - Phone:631-369-0777
Practice Address - Fax:631-369-0976
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151183207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00962340Medicaid
NY00962340Medicaid
NY71D811Medicare ID - Type Unspecified