Provider Demographics
NPI:1457358889
Name:MINKOVITZ, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:MINKOVITZ
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 1:1207 N SCOTT ST
Mailing Address - Street 2:EYE PHYSICIANS AND SURGEONS
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806
Mailing Address - Country:US
Mailing Address - Phone:302-652-3353
Mailing Address - Fax:302-656-9979
Practice Address - Street 1:1207 N SCOTT ST
Practice Address - Street 2:EYE PHYSICIANS AND SURGEONS
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-652-3353
Practice Address - Fax:302-656-9979
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004582207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000684701Medicaid
DEF89019Medicare UPIN
DE781452E81Medicare ID - Type Unspecified
DE008828C37Medicare PIN