Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 82673 | NY |
NPI | 1003902156 |
---|---|
Provider Name | Gerald S Mennin |
First Address | Yonkers, NY 10705-1947 |
Second Address | Yonkers, NY 10705-1947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00121706 | (05) | NY |
23228P | HIP HEALTH PLAN NY (01) | NY |
4096908 | AETNA (01) | NY |
48Z791 | EMPIRE BLUE CROSS BLUE SH (01) | NY |
B10497 | (02) | NY |
OH4152 | HEALTHNET (01) | NY |
WS005 | OXFORD HEALTH PLANS (01) | NY |