Provider Demographics
NPI:1124126818
Name:MINARDO, MICHAEL ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:MINARDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4223
Mailing Address - Country:US
Mailing Address - Phone:212-488-3400
Mailing Address - Fax:212-488-3401
Practice Address - Street 1:55 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4223
Practice Address - Country:US
Practice Address - Phone:212-488-3400
Practice Address - Fax:212-488-3401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX44781111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMM0X09V210OtherBCBS
NYP3192491OtherOXFORD
NY0001416OtherGHI
NY125142OtherACN
NY0466338000OtherAMERIHEALTH
NYX09V21Medicare PIN
NYT53038Medicare UPIN