Provider Demographics
NPI:1700116860
Name:LEO R. MINSKY, DC, PA
Entity Type:Organization
Organization Name:LEO R. MINSKY, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:MINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-421-1839
Mailing Address - Street 1:1265 S MILITARY TRL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7688
Mailing Address - Country:US
Mailing Address - Phone:954-421-1839
Mailing Address - Fax:
Practice Address - Street 1:1265 S MILITARY TRL
Practice Address - Street 2:SUITE 110
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7688
Practice Address - Country:US
Practice Address - Phone:954-421-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4031261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70709Medicare UPIN