Provider Demographics
NPI:1265898662
Name:MINLIONICA, ROBERT (DC, ATC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MINLIONICA
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 KRAMER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4226
Mailing Address - Country:US
Mailing Address - Phone:718-702-3659
Mailing Address - Fax:
Practice Address - Street 1:355 US HIGHWAY 22 E STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3581
Practice Address - Country:US
Practice Address - Phone:908-325-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002097002255A2300X
NY0029082255A2300X
NJ38MC00788700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer