Provider Demographics
NPI:1891885505
Name:MINAMOTO, GRACE Y (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:Y
Last Name:MINAMOTO
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 1:325 CENTRAL PARK W
Mailing Address - Street 2:APT 3-5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7630
Mailing Address - Country:US
Mailing Address - Phone:718-430-7318
Mailing Address - Fax:718-920-2746
Practice Address - Street 1:MMC - INFECTIOUS DISEASE
Practice Address - Street 2:111 EAST 210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-430-7318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152329207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease