Provider Demographics
NPI:1194725242
Name:WINSTON, MICHAEL HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:WINSTON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1598
Mailing Address - Country:US
Mailing Address - Phone:631-928-1555
Mailing Address - Fax:631-928-1570
Practice Address - Street 1:2 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1598
Practice Address - Country:US
Practice Address - Phone:631-928-1555
Practice Address - Fax:631-928-1570
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-09-30
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Provider Licenses
StateLicense IDTaxonomies
NY178825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F24006Medicare UPIN