Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 008103 | NY |
N | 111NR0400X | Rehabilitation Chiropractor | 008103 | NY |
NPI | 1770702045 |
---|---|
Provider Name | Dr. Michael Scott Minick |
First Address | Rye Brook, NY 10573-1022 |
Second Address | Bronx, NY 10461-3512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 23/09/2011 |