Provider Demographics
NPI:1871653840
Name:MODNY, CYNTHIA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JEAN
Last Name:MODNY
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 1:2402 E SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2815
Mailing Address - Country:US
Mailing Address - Phone:602-224-5554
Mailing Address - Fax:
Practice Address - Street 1:2402 E SAN MIGUEL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2815
Practice Address - Country:US
Practice Address - Phone:602-224-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22577207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E70399Medicare UPIN
AZZ26357Medicare ID - Type Unspecified